scholarly journals Pediatric multicompartmental trigeminal schwannoma: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Alexander P. Landry ◽  
Vincent C. Ye ◽  
Kerry A. Vaughan ◽  
James M. Drake ◽  
Peter B. Dirks ◽  
...  
Keyword(s):  
Skull Base ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Trigeminal Schwannoma ◽  
Skull Base Lesions ◽  
Cranial Fossa ◽  
Extradural Approach

BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

Surgical Approaches to the Cavernous Sinus: A Microsurgical Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 903-932 ◽  
Author(s):  
Tooru Inoue ◽  
Albert L. Rhoton ◽  
Dan Theele ◽  
Margaret E. Barry
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Anatomic Variants ◽  
Cranial Fossa ◽  
Extradural Approach

Abstract The surgical approaches to the cavernous sinus were examined in 50 adult cadaveric cavernous sinuses using magnification of ×3 to ×40. The following approaches were examined: 1) the superior intradural approach directed through a frontotemporal craniotomy and the roof of the cavernous sinus: 2) the superior intradural approach combined with an extradural approach for removing the anterior clinoid process and unroofing the optic canal and orbit; 3) the superomedial approach directed through a supraorbital craniotomy and subfrontal exposure to the wall of the sinus adjacent to the pituitary gland; 4) the lateral intradural approach directed below the temporal lobe to the lateral wall of the sinus; 5) the lateral extradural approach for exposure of the internal carotid artery in the floor of the middle cranial fossa proximal to the sinus; 6) the combined lateral and inferolateral approach, in which the infratemporal fossa was opened and the full course of the petrous carotid artery and the lateral wall of the sinus were exposed and; 7) the inferomedial approach, in which the medial wall of the sinus was exposed by the transnasal-transsphenoidal route. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exposed by each route are reviewed. The osseous relationships in the region were examined in dry skulls. Anatomic variants important in exposing the cavernous sinus are reviewed.

scholarly journals The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus

2020 ◽  
pp. 1-10
Author(s):  
Kenichi Oyama ◽  
Kentaro Watanabe ◽  
Shunya Hanakita ◽  
Pierre-Olivier Champagne ◽  
Thibault Passeri ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Middle Cranial Fossa ◽  
The Body ◽  
Middle Fossa Approach ◽  
Alternative Approach ◽  
Endoscopic Assistance ◽  
Skull Base Lesions ◽  
Cranial Fossa

OBJECTIVEThe anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.METHODSFive formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article.RESULTSVia the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2).CONCLUSIONSOpening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.

The Extended Middle Cranial Fossa Approach for the Treatment of Skull Base Lesions

2019 ◽  
Author(s):  
Noga Lipschitz ◽  
Gavriel Kohlberg ◽  
Joseph Breen ◽  
Myles Pensak ◽  
Mario Zuccarello ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Middle Cranial Fossa Approach ◽  
Skull Base Lesions ◽  
Cranial Fossa

The Course of the Lesser Petrosal Nerve on the Middle Cranial Fossa

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-15-ONS-23 ◽  
Author(s):  
Yukinari Kakizawa ◽  
Hiroshi Abe ◽  
Yutaka Fukushima ◽  
Kazuhiro Hongo ◽  
Hatem El-Khouly ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Geniculate Ganglion ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Three Bundles ◽  
Thin Bone ◽  
Cranial Fossa

Abstract Objective: The course of the lesser petrosal nerve is not well understood and may be confused with the course of the greater petrosal nerve during middle fossa surgery. The objective was to examine the course of the lesser petrosal nerve along the floor of the middle cranial fossa from the region of the geniculate ganglion to its outlet from the skull base. There are no studies focused on the course of this nerve in relationship to the floor of the middle cranial fossa. Methods: Twenty middle fossae from adult cadaveric specimens were examined using 3 to 40× magnification. Results: The lesser petrosal nerve was partially exposed on the floor of the middle fossa without drilling in 75% of the middle fossae and totally covered by thin bone in 25%. It crossed the floor anterior to the greater petrosal nerve and exited the middle fossa through the canaliculus innominatus in 14 cases, foramen spinosum in 3 cases, and the sphenopetrosal suture in 3 cases. The course of the lesser petrosal nerve has been shown in textbooks to be parallel to the greater petrosal nerve. However, the lesser and greater petrosal nerves diverged in the area medial to the geniculate ganglion in 90% of middle fossae with the angle of divergence averaging 11.6 degrees. The course of the lesser petrosal nerve was divided into three patterns based on the site of confluence of the three bundles of fibers forming the nerve. Conclusion: The relationships of the lesser petrosal nerve in the middle cranial fossa have been described. An understanding of these relationships will reduce the likelihood of it being confused with the greater petrosal nerve during surgical approaches to the middle fossa.

Endoscopic approaches to the trigeminal nerve and clinical consideration for trigeminal schwannomas: a cadaveric study

2012 ◽  
Vol 117 (4) ◽  
pp. 690-696 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Antonio Di Ieva ◽  
Manfred Tschabitscher
Keyword(s):  
Trigeminal Nerve ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Minimal Invasiveness ◽  
Trigeminal Schwannoma ◽  
Minimally Invasive Surgical ◽  
Anterior Petrosectomy ◽  
Cranial Fossa ◽  
Neurovascular Structures

Object The course of the trigeminal nerve straddles multiple fossae and is known to be very complex. Comprehensive anatomical knowledge and skull base techniques are required for surgical management of trigeminal schwannomas. The aims of this study were to become familiar with the endoscopic anatomy of the trigeminal nerve and to develop a minimally invasive surgical strategy for the treatment of trigeminal schwannomas. Methods Ten fresh cadavers were studied using 5 endoscopic approaches with the aid of 4-mm 0° and 30° endoscopes to identify surgical landmarks associated with the trigeminal nerve. The endoscopic approaches included 3 transcranial keyhole approaches (the extradural supraorbital, extradural subtemporal, and retrosigmoid approaches), and 2 endonasal approaches (the transpterygoid and the transmaxillary transpterygoid approaches). Results The trajectories of the extradural supraorbital, transpterygoid, and extradural subtemporal approaches corresponded with the course of the first, second, and third divisions of the trigeminal nerve, respectively. The 3 approaches demonstrated each division in intra- and extracranial spaces, as well as the Meckel cave in the middle cranial fossa. The interdural space at the lateral wall of the cavernous sinus was exposed by the extradural supraorbital and subtemporal approaches. The extradural subtemporal approach with anterior petrosectomy and the retrosigmoid approach visualized the trigeminal sensory root and its neighboring neurovascular structures in the posterior cranial fossa. The transmaxillary transpterygoid approach revealed the course of the third division in the infratemporal fossa. Conclusions The 5 endoscopic approaches effectively followed the course of the trigeminal nerve with minimal invasiveness. These approaches could provide alternative options for the management of trigeminal schwannoma.

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Resection of Skull Base Tumors

2019 ◽  
Author(s):  
Nauman Manzoor ◽  
Silky Chotai ◽  
Robert Yawn ◽  
Reid Thompson ◽  
Alejandro Rivas
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Skull Base Tumors ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa

scholarly journals Clinical, surgical and postoperative outcome analysis of tumors occupying both posterior and middle cranial fossa

2021 ◽  
Vol 18 (2) ◽  
pp. 36-44
Author(s):  
Rahul Singh ◽  
Ravi Shankar Prasad ◽  
Ramit Chandra Singh ◽  
Kulwant Singh ◽  
Anurag Sahu
Keyword(s):  
Postoperative Outcome ◽  
Middle Cranial Fossa ◽  
Posterior Cranial Fossa ◽  
Gross Total Resection ◽  
Outcome Analysis ◽  
Subtotal Resection ◽  
Combined Approach ◽  
Total Resection ◽  
Trigeminal Schwannoma ◽  
Cranial Fossa

Objectives: To analyse clinical, surgical and postoperative outcome perspectives of tumors occupying both middle and posterior cranial fossa. Materials and Methods: This retrospective cohort study includes 23 patients operated for tumors involving both middle and posterior cranial fossa in our department between August 2016 and August 2020. Each patient was evaluated for age, sex, co morbidities, tumour histopathology, clinical presentation, radiological characteristics, surgical and outcome characteristics. Unpaired t- test and chi-square test was used for statistical analysis. P < 0.05 was considered statistically significant. Results: The mean age was 46 years (range 40–57 years), with the majority of patients being female (56.5%). Most tumors (65.3%) were trigeminal schwannoma, with the remaining being vestibular schwannoma (21.7%), facial schwannoma (8.7%) and epidermoid (4.3%). The most commonly used surgical approach was the retrosigmoid approach (30.4%) and combined approach (30.4%).  Gross total resection (GTR) was done in 14 patients while subtotal resection (STR) was done in 9 patients. STR was significantly associated (p<0.05) with persisting cranial nerve deficit and tumour progression.  Midbrain compression, internal carotid artery and cavernous sinus involvement were significantly (p<0.05) associated with STR. Conclusions: Trigeminal schwannoma is the most common tumour involving both middle and posterior cranial fossa. Combined approach for such tumours is required in tumours having significant size in both middle cranial fossa and posterior cranial fossa. The intent of surgery is to achieve a gross total resection (GTR) but adhesions and involvement of critical brain structures results in STR.

scholarly journals Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

2017 ◽  
Vol 31 (04) ◽  
pp. 177-188 ◽  
Author(s):  
Soroush Farnoosh ◽  
Robert Kellman ◽  
Sherard Tatum ◽  
Jacob Feldman
Keyword(s):  
Skull Base ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
Surgical Access ◽  
Radiographic Testing ◽  
Cranial Nerve Injury ◽  
Cranial Fossa ◽  
Skull Base Anatomy ◽  
Neurovascular Structures

AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

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