Infratemporal fossa interdural approach for trigeminal neurinomas

Abstract

A small craniectomy in the infratemporal fossa incorporating the foramen ovale was used to resect 4 large trigeminal neurinomas. The tumour extended from the posterior cranial fossa and involved Meckel's cave and the lateral wall of the cavernous sinus in each instance. The dural sheath around the mandibular nerve and Gasserian ganglion was opened to expose the entire lesion. The head position and the surgeon's view of the tumour were modified to obtained a basal view. The craniectomy at this strategic site provided an avenue for control of the carotid artery at the petrous apex, avoided the need for brain retraction and permitted safe and complete resection of the tumours. The approach appears to be ideal for selected cases of trigeminal neurinomas.

Two patients with intracavernous haemangiopericytoma

“…An infratemporal fossa interdural approach, as we commonly use for surgery of trigeminal neurinomas, was adopted to resect the tumour. 4 However, the tumour was identified to be entirely within the cavernous sinus and not within its lateral dural wall. The exposure was extended and an extradural approach was adopted to resect the tumour.…”

Intracranial nonvestibular neurinomas: Young neurosurgeons′ experience

“…[20] The recurrence rate for cases with partial resection is relatively higher for trigeminal neuromas, compared with acoustic neuromas. [21] Konovalov et al .,[17] on the basis of a comparatively larger experience, highlight some important points for trigeminal neuroma surgery as follows: (1) These tumors are usually well separated from the cavernous sinus and the carotid artery, which facilitates their radical removal. (2) Usually the tumor does not completely destroy the trigeminal nerve, and some of its fibers can be preserved (preservation of the first trigeminal nerve division, if possible, is especially important).…”

Evolution in the Assessment and Management of Trigeminal Schwannoma

“…Samii et al 6 describe approaching these tumors via a frontotemporal craniotomy with or without zygomatic osteotomy, and advocate a wide transsylvian dissection to minimize temporal lobe retraction. Goel 40 describes an infratemporal fossa interdural approach, and Yoshida et al 7 describe a frontotemporal epidural‐interdural approach. Dolenc 21 also advocates a combined epidural/interdural dissection.…”

“…The most unusual of all the classes of trigeminal schwannomas, Type D tumors traditionally have required an extensive approach, such as the Fisch type C. The infratemporal fossa intradural approach described by Goel 40 may also be helpful for these tumors. Access to the pterygopalatine or infratemporal fossa can also be achieved endoscopically, via a combined endonasal/transmaxillary approach.…”