Department of Neurological Surgery, Division of Skull Base Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Department of Neurological Surgery, Division of Skull Base Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Clin Neurol Neurosurg. 2023 Jun;229:107723. doi: 10.1016/j.clineuro.2023.107723. Epub 2023 Apr 21.
Meningiomas involving the tentorium, comprising 3-6 % of all intracranial meningiomas, pose a great challenge for surgical excision due to their proximity to the deep neurovascular structures and complex anatomic boundries [1]. Depending on certain tumor characteristics and other anatomical findings, surgeons may attempt to tackle these lesions through a middle fossa, retrosigmoid or a single or multiple stage combination of approaches [2]. Here, we present a case of a 72-year-old male with severe left sided facial pain secondary to a homogenously enhancing mass arising in the left petro-tentorial junction, causing significant compression of the trigeminal nerve. After failing pharmacological therapy, the patient consented to surgical resection and decompression of the trigeminal nerve via a key hole retrosigmoid approach. This approach provided adequate exposure of the tumor and surrounding neurovascular structures, enabling safe microsurgical removal of the lesion while minimizing the amount of tissue disruption. Due to the small surgical foot print of the approach, the patient was able to be discharge quickly from the hospital with minimal post-surgical pain. We describe the key surgical steps and reconstruction technique.
累及小脑幕的脑膜瘤占所有颅内脑膜瘤的 3-6%，由于其靠近深部神经血管结构和复杂的解剖边界，因此对手术切除构成了巨大挑战[1]。根据某些肿瘤特征和其他解剖学发现，外科医生可能会尝试通过中颅窝、乙状窦后或单一或多种阶段的联合方法来处理这些病变[2]。在这里，我们介绍了一例 72 岁男性患者，因左侧岩-天幕交界处均质强化肿块引起严重左侧面部疼痛，导致三叉神经明显受压。在药物治疗失败后，患者同意通过锁孔乙状窦后入路进行手术切除和三叉神经减压。该入路提供了肿瘤和周围神经血管结构的充分暴露，能够安全地进行微创手术切除病变，同时最大限度地减少组织损伤。由于该入路的手术足迹小，患者能够很快出院，术后疼痛极小。我们描述了关键的手术步骤和重建技术。
