Oberman Dan Zimelewicz, Plou Pedro, Campero Alvaro, Ajler Pablo Marcelo
Department of Neurosurgery, Air Force Galeão Hospital, Rio de Janeiro, Brazil.
Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Surg Neurol Int. 2022 Nov 25;13:554. doi: 10.25259/SNI_632_2022. eCollection 2022.
Tentorial meningiomas (TM) are complex entities with distinguished clinical, radiological and surgical considerations. They comprise approximately 3 - 6% of all intracranial meningiomas1. TM have been classified in 5 subgroups according to the modified Yasargil's classification, based on their location 2 and 3. Those located at the free margin of the tentorium are still challenging for neurosurgeons, with high morbidity and mortality. Atypical trigeminal neuralgia (ATN) is a type of trigeminal neuralgia that is identified by the constancy of symptoms. They experience less intense pain, but a constant dull aching or burning pain, and it is frequently misdiagnosed. Although it is well known that typical trigeminal (TN) neuralgia responds very well to medical treatment and are related with posterior fossa tumors, ATN is less likely. In this video we demonstrate the microsurgical resection of group 1 tentorial meningioma in the treatment of atypical trigeminal neuralgia.
A previously healthy 63-year-old female came to our service complaining of long lasting, intermittent, right facial pain for two years. On neurological examination, the patient had hypoesthesia in the territory of maxillae (V2) branch of the right trigeminal nerve. She had no other complaints on the physical examination. Initial treatment with carbamazepine and pregabalin was performed, however, it could not be further increased because of the maximal doses and side effects. Radiological investigation was carried out with cranial computed tomography (CT) and magnetic resonance image (MRI), which showed a high signal density mass lesion in the free margin of the tentorium, with extension to the right cerebello pontine angle (CPA), compressing the trigeminal nerve, that exhibited homogeneous contrast enhancement, suggestive of tentorial meningioma. Given the size, the location of the mass, and no response to the medical treatment, microsurgical resection was performed.
The postoperative period was excellent, without any neurological deficit. The patient consented with publication of her images and videos.
小脑幕脑膜瘤（TM）是一类复杂的疾病，在临床、影像学及手术方面均有独特的考量。它们约占所有颅内脑膜瘤的3% - 6%。根据改良的亚萨吉尔分类法，TM可分为5个亚组，分类依据是其位置。位于小脑幕游离缘的肿瘤对神经外科医生来说仍是一项挑战，其发病率和死亡率都很高。非典型三叉神经痛（ATN）是三叉神经痛的一种类型，其症状具有持续性。患者疼痛程度较轻，但有持续的隐痛或灼痛，且常被误诊。虽然众所周知典型三叉神经痛（TN）对药物治疗反应良好且与后颅窝肿瘤有关，但ATN则不然。在本视频中，我们展示了1型小脑幕脑膜瘤的显微手术切除治疗非典型三叉神经痛的过程。
一位63岁既往健康的女性前来就诊，主诉右面部长期、间歇性疼痛两年。神经系统检查发现，患者右侧三叉神经上颌支（V2）分布区感觉减退。体格检查无其他异常。最初给予卡马西平和普瑞巴林治疗，但因最大剂量及副作用无法进一步增加剂量。行头颅计算机断层扫描（CT）和磁共振成像（MRI）检查，结果显示小脑幕游离缘有一高信号密度肿块，延伸至右侧小脑脑桥角（CPA），压迫三叉神经，肿块呈均匀强化，提示为小脑幕脑膜瘤。鉴于肿块大小、位置及药物治疗无效，遂行显微手术切除。
术后恢复良好，无任何神经功能缺损。患者同意公布其影像资料。
