Advertisement
Research Article| Volume 110, P1-3, April 2023

Download started.

Ok

Combined Anterior (Kawase) and Posterior Petrosectomy (pre-sigmoid/ retro-labyrinthine) for Resection of Post-Radiosurgery Recurrent Cavernous Sinus and Meckel’s cave Meningioma; with Simultaneous Microvascular Decompression for Trigeminal Neuralgia: 2 Dimensional Operative video, and Review of Literature

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gomes da Silva Vinicius Trindade
        • Gomes Marcos Queiroz Teles
        • Maria Leila
        • da Roz Vitor
        • Yamaki Nagai
        • do Espirito Santo Prudente
        • Teixeira Manoel Jacobsen
        • Figueiredo Eberval Gadelha
        Petroclival Meningioma Leading to Trigeminal Neuralgia: A Kawase Approach Application.
        World Neurosurg. 2021; 151: 110-116
        • Hirata Sachiko
        • Kobayashi Masahito
        • Kamamoto Dai
        • Kosugi Kenzo
        • Yoshida Kazunari
        • Fujimaki Takamitsu
        Trigeminal Neuralgia Due to Petrosal Bone Deformity.
        World Neurosurg. 2019; 126: 79-82
        • Martínez-Pérez Rafael
        • Silveira-Bertazzo Giuliano
        • Rangel Gustavo G.
        • Albiña Pablo
        • Hardesty Douglas
        • Carrau Ricardo L.
        • Prevedello Daniel M.
        The historical perspective in approaches to the spheno-petro-clival meningiomas.
        Neurosurg Rev. 2021; 44: 51-60
        • Abdel Aziz K.M.
        • Sanan A.
        • van Loveren H.R.
        • Tew Jr, J.M.
        • Keller J.T.
        • Pensak M.L.
        Petroclival meningiomas: predictive parameters for transpetrosal approaches.
        Neurosurgery. 2000; 47 (discussion 150-2): 139-150
        • Gross A.
        • Tavanaiepour Daryoush
        • Rose Du
        • Al-Mefty Ossama
        • Dunn Ian F.
        Evolution of the posterior petrosal approach Bradley.
        Neurosurg Focus. 2012; 33: E7
        • Burhan Janjua M.
        • Caruso James P.
        • Greenfield Jeffrey P.
        • Souweidane Mark M.
        • Schwartz Theodore H.
        The combined transpetrosal approach: Anatomic study and literature review.
        J Clin Neurosci. 2017; 41: 36-40
        • Cheung Steven W.
        • Russell Matthew S.
        • Pross Seth E.
        Role of the neurotologist in posterior fossa meningioma surgery.
        Handb Clin Neurol. 2020; 170: 115-131
        • Rigante Luigi
        • Herlan Stephan
        • Tatagiba Marcos Soares
        • Stanojevic Milan
        • Hirt Bernhard
        • Ebner Florian Heinrich
        Petrosectomy and Topographical Anatomy in Traditional Kawase and Posterior Intradural Petrous Apicectomy (PIPA) Approach: An Anatomical Study.
        World Neurosurg. 2016; 86: 93-102
        • Cho Chang Weon
        • Al-Mefty Ossama
        Combined petrosal approach to petroclival meningiomas.
        Neurosurgery. 2002; 51 (discussion 716-8): 708-716
        • Hanakita Shunya
        • Watanabe Kentaro
        • Champagne Pierre-Olivier
        • Froelich Sébastien
        How I do it: combined petrosectomy.
        Acta Neurochir (Wien). 2019; 161: 2343-2347
        • Behari S.
        • Tyagi I.
        • Banerji D.
        • Kumar V.
        • Jaiswal A.K.
        • Phadke R.V.
        • Jain V.K.
        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
        • Liu James K.
        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
        • Liao C.H.
        • Wang J.T.
        • Lin C.F.
        • Chen S.C.
        • Lin C.J.
        • Hsu S.P.C.
        • Chen M.H.
        Pretemporal trans-Meckel's cave transtentorial approach for large petroclival meningiomas.
        Neurosurg Focus. 2018; 44: E10
        • Troude L.
        • Baucher G.
        • Lavieille J.-P.
        • Roche P.-H.
        The presigmoid retrolabyrinthine approach: Technical note.
        Neurochirurgie. 2021; 67: 503-507
        • Graffeo M.-C.
        • Perry A.
        • Carlstrom L.P.
        • Driscoll C.L.W.
        • Link M.J.
        • Neurol Surg J.
        • et al.
        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
        • Morisako Hiroki
        • Goto Takeo
        • Ohata Hiroki
        • Goudihalli Sachin Ranganatha
        • Shirosaka Keisuke
        • Ohata Kenji
        Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach.
        Neurosurg Focus. 2018; 44: E11
        • Morisako Hiroki
        • Ohata Hiroki
        • Shinde Bharat
        • Nagahama Atsufumi
        • Watanabe Yusuke
        • Goto Takeo
        Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas.
        J Neurosurg. 2021; 19: 1-10
        • Lee Won Jae
        • Hong Sang Duk
        • Woo Kyung In
        • Seol Ho Jun
        • Choi Jung Won
        • Lee Jung-Il
        • Nam Do-Hyun
        • Kong Doo-Sik
        Endoscopic endonasal and transorbital approaches to petrous apex lesions.
        J Neurosurg. 2021; 136: 431-440
        • Topczewski T.E.
        • Di Somma A.
        • Pineda J.
        • Ferres A.
        • Torales J.
        • Reyes L.
        • Morillas R.
        • Solari D.
        • Cavallo L.M.
        • Cappabianca P.
        • Enseñat J.
        • Prats-Galino A.
        Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways.
        Acta Neurochir (Wien). 2020; 162: 2097-2109