Dumbbell trigeminal schwannoma in a child: complete removal by a one-stage pterional surgical approach

Verstappen, C.C.P.; Beems, Tjemme; Erasmus, Corrie E.; Lindert, Erik J. van

doi:10.1007/s00381-004-1091-3

Cited by 16 publications

(18 citation statements)

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“…The subarachnoid space extends forward within Meckel's cave to approximately the midportion of the gasserian ganglion. Disruption in Meckel's cave may lead to various abnormalities, among which trigeminal schwannomas (TS) and meningiomas are the most common [2][3][4] . Many surgical approaches to the lesions in Meckel's cave have been reported [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

et al. 2009

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Objective To provide a new approach for the treatment of tumor in Meckel's cave, by dissecting adjacent structures of the nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel's cave approach. Methods Fifteen adult cadaver heads (30 sides) were dissected and the correlated anatomic landmarks were observed, measured and analyzed in an operative route. Results The approach was divided into 3 steps: entering the maxillary sinus, the later pterygopalatine fossa and the final Meckel's cave. Safe access to Meckel's cave could be achieved by tracing the vidian neurovascular bundles and dissecting the quadrangular space (QS). The distances from the nasal columella to the apertura maxillaries, the sphenopalatine foramen, and the anterior foramen of the pterygoid canal were (44.08±2.61) mm, (64.83±2.42) mm, and (70.43±2.94) mm, respectively.The angles between the horizontal plate of the palatine bone and the link from nasal columella to apertura maxillaries, between the horizontal plate of the palatine bone and the link from nasal columella to sphenopalatine foramen were (38.10±2.46)° and (26.15±2.26)°, respectively. Conclusion The endoscopic approach of transnasal maxillary sinus-pterygopalatine fossaMeckel's cave (ENMPA) is a safe and direct way to access Meckel's cave, and could be employed for the treatment of tumor in Meckel's cave.

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Section: Introductionmentioning

confidence: 99%

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

et al. 2009

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“…1,2 Although very few pediatric cases of trigeminal schwannomas have been reported in the literature, 3,4 to our knowledge, this is the first case of an atypical meningioma along the trigeminal nerve in a pediatric patient.…”

Section: Discussionmentioning

confidence: 80%

Atypical Cystic Meningioma of the Trigeminal Nerve in a Pediatric Patient

Obeng¹,

Rumboldt²,

Tuite³

et al. 2008

American Journal of Neuroradiology

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SUMMARY:We report an unusual case of atypical cystic meningioma of the trigeminal nerve proved by histology in a 15-year-old white girl. A review of the literature showed that this is only the second reported case of a meningioma of the trigeminal nerve without dural attachment and the first occurrence in a pediatric patient. P rimary tumors of the trigeminal nerve and Meckel cave represent less than 0.5% of intracranial tumors.1 We report the case of a dumbbell-shaped atypical meningioma of the trigeminal nerve without dural attachment, involving the Meckel cave and the posterior fossa in an adolescent. Case ReportA 15-year-old white girl presented with a 2-month history of leftsided facial numbness and loss of sensation of the left hemitongue. Physical examination showed hypoesthesia in the left V1, V2, and V3 dermatome distribution and absent left corneal reflex. She had no family history of neurofibromatosis, and physical examination revealed no evidence of café au lait spots or freckling in the axillary or inguinal area. Aside from the absence of a left corneal reflex, the findings of the ophthalmologic examination were unremarkable, with no evidence of lens abnormalities. A brain MR imaging revealed an extra-axial dumbbell-shaped cystic mass, without obvious "dural tail" or dural attachment, demonstrating peripheral rim enhancement (Fig 1), with a cystic component in the posterior fossa at the root entry zone of the left trigeminal nerve, and a second cystic lesion with a fluid-fluid level at the level of the left Meckel cave. The mass was thought to be consistent with a cystic schwannoma of the left trigeminal nerve. There were no masses along the course of the 8 cranial nerves.A 1-stage surgical excision of the middle and posterior fossa components of the mass was planned. The patient underwent a left-sided skull base craniotomy, with a left temporal craniotomy and zygomatic osteotomy, by using an extradural approach. At surgery, it was noted that the mass arose from the left trigeminal nerve, did not have a dural attachment, and was heavily intermixed with the surrounding trigeminal nerve. Surgical resection of the mass was thought to be complete.The resected gross specimen consisted of multiple fragments of brown-red variegated tissue. Histology (Fig 2) showed concentric structures typical of meningioma, hypercellularity, mitotically active foci, and focal necrosis, making it atypical. Embedded nerve fascicles of the excised trigeminal nerve appeared infiltrated by tumor. Reticulin stain showed chiefly perivascular staining in the tumor, highlighting its vascularity. A final diagnosis of atypical meningioma was made.Given the histology and the location of the neoplasm, we planned to treat residual or recurrent tumor with stereotactic radiosurgery. Since surgery, a postoperative MR imaging and subsequent follow-up MR imaging performed every 2 months in the last 4 months did not demonstrate evidence of macroscopic residual or recurrent tumor.Findings of an MR imaging of the cervical spine performed 2 mon...

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“…Major impediment to complete removal is inadequate exposure due to deep location of the tumor and close proximity to vital neuro-vascular structures. The ideal surgical approach should be shortest and direct as well as wide and low so as to avoid the need for prolonged and excessive brain retraction.Verstappen et al [11] reported a case of trigeminal neurinoma of maximum diameter of 53mm, centered over Meckel , s cave in a 6 year old girl removed by single stage pterional approach. However with pterional approach it is difficult to remove large posterior fossa component as was in our case.…”

Section: Discussionmentioning

confidence: 99%

“…The tumor that straddle the middle and posterior cranial fossae and do not extend below the internal auditory canal can be removed through a middle fossa approach [2,11]. The combined approach is employed for large dumbbell shaped tumors that extend ventral to the lower brainstem and below the internal acoustic meatus [2,11]. Various reports have stressed the need for radical surgery so as to achieve higher cure rates.…”

Section: Discussionmentioning

confidence: 99%

“…Multi-compartmental tumors are removed by different combined approaches [7,9,10]. The tumor that straddle the middle and posterior cranial fossae and do not extend below the internal auditory canal can be removed through a middle fossa approach [2,11]. The combined approach is employed for large dumbbell shaped tumors that extend ventral to the lower brainstem and below the internal acoustic meatus [2,11].…”

Section: Discussionmentioning

confidence: 99%

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Giant Multi-Compartmental Trigeminal Neurinoma in a Child: A Case Report

Singh¹

2011

TONEUROSJ

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Abstract:We report a case of solitary giant multi-compartmental trigeminal neurinoma in a 10 year old female child, without the stigmata of neurofibromatosis.The child presented with headache, vomiting, dysarthria, diplopia and altered sensorium.Neuroimaging revealed a giant multi-compartmental trigeminal neurinoma measuring 6.8 x 4.3 x 4.0 cm in size. The tumor was successfully removed by single stage petrosal approach. It is extremely rare for a solitary giant neurinoma to occur at this site in a child without neurofibromatosis. Advantages of petrosal approach in such type of tumor are discussed. As per author's knowledge, this is the largest trigeminal neurinoma reported till date in a child.

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Dumbbell trigeminal schwannoma in a child: complete removal by a one-stage pterional surgical approach

Abstract: Trigeminal schwannoma is a tumour that occurs rarely in childhood. Although several, often multistaged surgical strategies have been reported in the literature, this tumour was eradicated by a one-stage pterional approach.

Cited by 16 publications

References 11 publications

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

Atypical Cystic Meningioma of the Trigeminal Nerve in a Pediatric Patient

Giant Multi-Compartmental Trigeminal Neurinoma in a Child: A Case Report

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