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J Neurol Surg B Skull Base 2016; 77(02): 150-160
DOI: 10.1055/s-0036-1571838
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Intracranial Management of Perineural Spread in the Trigeminal Nerve

Michael J. Redmond
1   Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
2   Department of Neurosurgery, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
3   Department of Surgery, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
,
Benedict J. Panizza
1   Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
3   Department of Surgery, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
4   Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
09 March 2016 (online)

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Abstract

Since the mid-1960s surgeons have attempted to cure intracranial perineural spread (PNS) of cutaneous malignancies. Untreated patients with trigeminal PNS die from brainstem invasion and leptomeningeal disease. It was understood that resection with clear margins was potentially curative, but early surgical attempts were unsuccessful. The prevailing wisdom considered that this surgery failed to improve the results achieved with radiation therapy alone and was associated with high morbidity. However, with improved imaging, surgical equipment, and better understanding of cavernous sinus (CS) anatomy and access, contemporary surgeons can improve outcomes for this disease. The aim of this paper is to describe a technique to access the interdural compartment of the CS and treat PNS of cutaneous squamous cell carcinoma (cSCC) in the intracranial trigeminal nerve and ganglion. It is based on the experience of the Queensland Skull Base Unit, Australia in managing PNS of cutaneous squamous cell carcinoma of the head and neck (cSCCHN).

Keywords

perineural spread - Meckel cave - cavernous sinus - interdural surgery

Note

This paper has not been presented or published elsewhere.


 

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