Matsuyama T, Shimomura T, Kawata K, Ohnishi H
Department of Neurosurgery, Seikeikai Hospital, Osaka, Japan.
No Shinkei Geka. 1996 Jun;24(6):563-6.
A case of a huge skull base neurofibroma completely resected by a combined subtemporal-infratemporal and basal subfrontal approach is reported. A 32-year-old female complained of left facial paresthesia and deformity since several months before. Neurological examination revealed hypesthesia in the distribution of the left trigeminal nerve second branch. CT and MRI images showed a huge tumor in the infratemporal fossa, parapharyngeal space and middle fossa extending into the cavernous sinus, compressing the left temporal lobe and distorting the left hypothalamus and the brain stem. The patient tolerated trial balloon occlusion of the left internal carotid artery for 45 minutes. Transmaxillary biopsy revealed the tumor to be a neurofibroma. Through a combined basal subfrontal and a subtemporal-infratemporal approach in two staged operations, total tumor resection was performed. This tumor originated at the second branch of the trigeminal nerve. We recommend these combined approaches and two staged operations for such a huge skull base tumor as presented in this case.
报告了1例采用颞下-颞下窝联合额下基底入路完全切除的巨大颅底神经纤维瘤病例。一名32岁女性自数月前起出现左侧面部感觉异常和畸形。神经学检查发现左侧三叉神经第二支分布区感觉减退。CT和MRI图像显示颞下窝、咽旁间隙和中颅窝有一个巨大肿瘤，延伸至海绵窦，压迫左侧颞叶，使左侧下丘脑和脑干变形。患者耐受了左侧颈内动脉试验性球囊闭塞45分钟。经上颌活检显示肿瘤为神经纤维瘤。通过在两个阶段的手术中采用额下基底联合颞下-颞下窝入路，进行了肿瘤全切。该肿瘤起源于三叉神经第二支。对于本病例中如此巨大的颅底肿瘤，我们推荐这些联合入路和两阶段手术。
