Highlights
- •Combined anterior and posterior petrosectomy skull approach in the same patient.
- •Treatment of patient with trigeminal neuralgia due to Meckels cave meningioma and superior cerebellar artery conflict.
- •The entire length of the Trigeminal nerve from the brainstem till the 3 division of the nerve are depicted.
Abstract
Background
A 70-year male had previous gamma knife (GK) for left cavernous sinus and Meckel’s
cave meningioma for facial numbness. He presented 11 years later with facial pain
(both typical and atypical) and worsening numbness.
Observations
MRI showed tumor growth and an infratentorial extension. FIESTA MRI showed left superior
cerebellar artery (SCA) contact with the V nerve root entry zone (REZ) accounting
for Type 1/ lancinating pain. After discussing available options, he opted for surgery.
Lumbar drain, and a middle fossa anterior petrosectomy (Kawase) combined with posterior
petrosectomy (retrolabyrinthine) approach was employed to perform tumor debulking
along with microvascular decompression (mobilization of SCA). SSEP, BAERS, MEP, V
nerve monitoring were performed. Fat graft was used for multilayered closure. He experienced
resolution of both type 1 & type 2 facial pain, improvement in sensation in V3. Symptomatic
improvement was recorded at 11 months follow up.
Lessons: The combined skull base approach provided visualization of the entire length of V
nerve (Cisternal, Meckel’s cave, V2 and V3) allowing for decompression at various
points to achieve relief of both types of facial pain.
The patient provided consent for use of his images and operative video for publication.
Keywords
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References
- Petroclival Meningioma Leading to Trigeminal Neuralgia: A Kawase Approach Application.World Neurosurg. 2021; 151: 110-116
- Trigeminal Neuralgia Due to Petrosal Bone Deformity.World Neurosurg. 2019; 126: 79-82
- The historical perspective in approaches to the spheno-petro-clival meningiomas.Neurosurg Rev. 2021; 44: 51-60
- Petroclival meningiomas: predictive parameters for transpetrosal approaches.Neurosurgery. 2000; 47 (discussion 150-2): 139-150
- Evolution of the posterior petrosal approach Bradley.Neurosurg Focus. 2012; 33: E7
- The combined transpetrosal approach: Anatomic study and literature review.J Clin Neurosci. 2017; 41: 36-40
- Role of the neurotologist in posterior fossa meningioma surgery.Handb Clin Neurol. 2020; 170: 115-131
- Petrosectomy and Topographical Anatomy in Traditional Kawase and Posterior Intradural Petrous Apicectomy (PIPA) Approach: An Anatomical Study.World Neurosurg. 2016; 86: 93-102
- Combined petrosal approach to petroclival meningiomas.Neurosurgery. 2002; 51 (discussion 716-8): 708-716
- How I do it: combined petrosectomy.Acta Neurochir (Wien). 2019; 161: 2343-2347
- Postauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails.Acta Neurochir (Wien). 2010; 152: 1633-1645
- Extended middle fossa approach with anterior petrosectomy for resection of upper petroclival meningioma involving Meckel's cave: operative video and technical nuances.Neurosurg Focus. 2017; 43: V8
- Pretemporal trans-Meckel's cave transtentorial approach for large petroclival meningiomas.Neurosurg Focus. 2018; 44: E10
- The presigmoid retrolabyrinthine approach: Technical note.Neurochirurgie. 2021; 67: 503-507
- Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Posterior Petrosal Approach Christopher S.Skull Base. 2019; 80: 338-351
- Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach.Neurosurg Focus. 2018; 44: E11
- Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas.J Neurosurg. 2021; 19: 1-10
- Endoscopic endonasal and transorbital approaches to petrous apex lesions.J Neurosurg. 2021; 136: 431-440
- Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways.Acta Neurochir (Wien). 2020; 162: 2097-2109
Article info
Publication history
Accepted:
February 3,
2023
Received:
December 13,
2022
Identification
Copyright
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