Surgery for a Case of Three-Compartment Trigeminal Schwannoma : Technical Aspects

Abstract

J Korean Neurosurg Soc 48 : [383][384][385][386][387] 2010 Complete removal of three-compartment trigeminal schwannomas is a challenge to neurosurgeons. To expand exposure of each compartment, the combination and modification of skull base approaches are necessary. The 61-year-old woman was admitted with chronic headache. Preoperative magnetic resonance imaging showed 47×50×40 mm-sized tumor originating primarily in the middle cranial fossa extended to the posterior and the infratemporal fossa. We performed operation in five stage; 1. Zygomatic osteotomy, 2. Inferior temporal fossa plate removal and foramen ovale opening, 3. Cavernous sinus opening, 4. Tailored anterior petrosectomy, 5. Meckel's cave opening. Combination of skull base surgery should be concerned according to the patient. In this study, extradural basal extension with zygomatic osteotomy, interdural posterior extension with tailored anterior petrosectomy, and intracavernous exploration are reasonable options for remodeling three-compartment lesion into a single compartment. Tailoring of bone resection and exploring through natural pathway between meningeal layers accomplish single-stage operation for complete removal of tumors.

Single stage complete removal of dumbbell trigeminal schwannoma in a child by skull base approach

“…However, combined approaches (e.g., cranial-orbital-zygomatic and anterior transpetrosal approaches or subtemporal and suboccipital approaches) carry the risk of venous injury and injury from excessive retraction. [ 10 11 12 13 ]…”

“…Dumbbell tumors extending beyond the seventh–eighth complex and reaching until the lower brainstem are difficult to remove in one stage and may require multiple sittings. [ 1 13 14 ] However, the total surgical removal of large, multi-compartmental tumor may be achieved through a surgical approach from a single cranial fossa aided by soft internal consistency of the tumor, expanded Meckel's cave and convenient cleavage planes. Although an anterior approach can provide excellent access to the posterior fossa through the enlarged Meckel cave, the reverse is not the case, and hence, a posterior fossa approach provides a limited access to the portion of tumor located in the middle fossa.…”

“…Although an anterior approach can provide excellent access to the posterior fossa through the enlarged Meckel cave, the reverse is not the case, and hence, a posterior fossa approach provides a limited access to the portion of tumor located in the middle fossa. [ 13 14 15 ]…”

Pediatric multicompartmental trigeminal schwannoma: illustrative case

“…Consequently, they can be found in anatomical permutations of the posterior cranial fossa; middle cranial fossa/Meckel’s cave; and, rarely, extracranial spaces (e.g., orbit, pterygopalatine fossa, or infratemporal fossa). 8 Importantly, tumors with tricompartmental extension (i.e., extracranial, middle fossa, and posterior fossa) are particularly rare and challenging to treat.…”

A Rare Case of Hearing Impairment due to Cerebello-Pontine Angle Lesion: Trigeminal Schwannoma

“…Schwannoma of the trigeminal nerve comprises only 0.2% to 0.4% of all intracranial tumors and primarily arises in the Gasserian ganglion [2] . They are relatively rare and less common than vestibular schwannoma [3] .…”