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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Article info
Publication history
Accepted:
February 3,
2023
Received:
December 13,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
