ABSTRACT
Background: The surgery of dumbbell-shaped trigeminal neurinomas (TN) remains one of the most formidable challenges for neurosurgeons because of its location at great depth in the cranium and proximity to vital neurovascular structures. Objective: To describe the feasibility of a novel technique, synchronous endoscopy and microsurgery via combined far-lateral supracerebellar-infratentorial and subtemporal approach, for resection of this rare entity. Methods: A 53-year-old women presented with progressive left facial numbness for 2 months. Imaging examinations revealed a left-sided dumbbell-shaped TN afflicting the middle and posterior cranial fossa, and a single-stage combined multiportal endoscopic microscopic approach was attempted for tumor resection. Initially, a purely endoscopic far-lateral supracerebellar-infratentorial approach was used to remove the posterior fossa component with the aid of tentorium incision. Subsequently, a microsurgical subtemporal interdural approach was performed for the exposure and separation of tumor within the Meckel cave. Finally, the tumor was pushed into the porus trigeminus under microscopy, thus enabling tumor extraction for the supracerebellar space under endoscopy without anterior petrosectomy. Results: The patient evolved favorably without additional neurological deficit after surgery, and postoperative imaging showed a complete resection of the tumor. Conclusion: We describe the first account of multi-corridor hybrid surgery for removal of TN in a dumbbell configuration, which enables one-stage total tumor removal with minimal added morbidity. This hybrid technique may be an effective piece of the surgeon's armamentarium to improve outcomes of patient with complex skull-base lesions. Further studies with larger case numbers are warranted to confirm the prognostic significance of this technique.
ABSTRACT
We present a 52-year-old male case of right trigeminal neurinoma at lateral cavernous sinus. The tumor was 40 mm in maximum diameter, obviously compressed temporal lobe and encased internal carotid artery. Extradural middle fossa and transcavernous approach was applied and the tumor was resected via Parkinson's triangle. This approach enabled safe and effective tumor resection, sufficient visualization, and operative field ( Figs. 1 and 2 ). We performed dissection of the tumor from trigeminal nerve, tentorium, and middle fossa and resect the tumor around internal carotid artery sufficiently. Postoperative course was good without any new neurological deficit. This surgical method is considered safe and effective for the resection of the tumor at lateral cavernous sinus. The link to the video can be found at: https://youtu.be/2ekuILIgEuo.
ABSTRACT
The expression of epidermal growth factor receptor (EGFR) and leucine-rich repeats and immunoglobulinqike domain 1 (LRIG-1) in humantrigeminal neurinoma was investigated and their effect on the origination and development of trigeminal neurinoma, and the relationship between them was studied. By using immunohistochemistry with tissue chip, the expression of EGFR and LRIG-1 was detected in 23 cases of trigeminal neurinoma. It was found that in the 23 cases, the expression rate of EGFR was 21.74 %, while that of the LRIG-1 was 78.26 %. There was a negative correlation between them. It wassuggested that LRIG-1 might inhibit the malignant differentiation and proliferation of the trigeminal neurinoma possibly by the negative feedback loop of EGFR.
ABSTRACT
A consecutive series of 16 patients with trigeminal neurinoma have been managed surgically at seoul National University Hospital duriny the last nine years. Five patients had tumors confined to the middle fossa arising from the trigeminal ganglion, four had posterior fossa tumors arising from the trigeminal root, and seven had "dumbbell" lesions extending above and below the tentorium. In four patients, tumor had also invaded cavernous sinus. A two stage operation was done in two cases with "dumbbell"-shaped tumors. A total tumor excision was achieved in ten patients ; all remain free of recurrence 4 to 77 months after surgery. A subtotal tumor excision was performed in six cases. There were no operative deaths nor major morbidity. Trigeminal nerve dysfunction persisted or was aggravated in ten cases. Six patients had preserved or improved the trigeminal function after treatment. Selection of the appropriate surgical approaches to the various types of tumor location and growth pattern was important for successful operations.
Subject(s)
Humans , Cavernous Sinus , Infratentorial Neoplasms , Neurilemmoma , Recurrence , Seoul , Trigeminal Ganglion , Trigeminal NerveABSTRACT
We reported a case of huge cystic trigeminal neurinoma. The patient was 35 year old female with trigeminal nerve dysfunction and hemiparesis. The computed tomography disclosed a huge cystic low density mass at the temporal base and suprasellar cistern that extended to cerebellopontine cistern through the tentorium, and enlargement of Meckel's cave on coronal scan. Through the infratemporal and retromastoid suboccipital approach, the cystic content was aspirated and cyst wall was removed. The cystic change of neurinoma may be due to mucoid degeneration and liquifaction.
Subject(s)
Adult , Female , Humans , Neurilemmoma , Paresis , Trigeminal NerveABSTRACT
The authors reviewed one hundred and twenty cases of cerebellopontine angle(CPA) tumors that were operated upon at the department of neurosurgery of Seoul National University Hospital between 1977 and 1987. The pathologic diagnosis of the tumors were acoustic neurinoma(66%), meningioma(13%), epidermoid(5%) and trigeminal neurinoma(5%). The age incidence was most frequent in the 5th and the 6th decades and 6.7% of cases occurred at the pediatric ages. Acoustic neurinomas were frequent in the 5th decade and on admission more than half of patients were poor clinical grades with large tumors more than 3cm in diameter(78.5%). There was good correlation between the clinical grade and tumor size on admission. All of the acoustic tumors were operated through the suboccipital transmeatal approach and total removal was possible in 73% with 5% of motality rate. Facial nerve was preserved in 62% of total removal-cases and the size of tumor was the important factor for the total removal of tumor with preservation of facial nerve. Cerebellopontine angle meningioma comprised 13% of all CPA tumors and incidence of male to female ratio was 2:13. Operations were performed either through retromastoid suboccipital approach or combined supra-infratentorial approach. Total temoval was possible in 67% without mortality. Six trigeminal neurinomas were located:one in the middle fossa, one in the posterior fossa and the other four cases appearing as dumbbell shape. Total removal was possible in two cases and subtotal removal in four cases and the outcome was rather good in all cases. Pediatric CPA tumors were two each of medulloblastomas and ependymomas and one each of astrocytoma, primitive neuroectodermal tumor(PNET) and trigeminal neurinoma, Masson's hemagioendothelioma. Total removal was possible in four cases and the outcome was good in all cases.
