CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 05): S391-S392
DOI: 10.1055/s-0038-1669977
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Presigmoid Approach to Dumbbell Trigeminal Schwannoma

Katherine E. Kunigelis
1  Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
,
Daniel Craig
1  Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
,
Alexander Yang
1  Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
,
Samuel Gubbels
2  Department of Otolaryngology, University of Colorado Hospital, Aurora, Colorado, United States
,
A. Samy Youssef
1  Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
› Author Affiliations
Further Information

Address for correspondence

A. Samy Youssef, MD, PhD
Department of Neurosurgery, University of Colorado Hospital
12631 East 17th Avenue
Box C307, Aurora, CO 80045
United States   

Publication History

28 April 2018

12 August 2018

Publication Date:
25 September 2018 (eFirst)

 

    Abstract

    This case is a 15-year-old male, presenting with headaches, right face, and arm numbness, and ataxia. MRI (magnetic resonance imaging) revealed a large right sided dumbbell shaped lesion, extending into the middle and posterior fossa with compression of the brainstem consistent with a trigeminal schwannoma. Treatment options here would be a retrosigmoid suprameatal approach or a lateral presigmoid approach. Given the tumor extension into multiple compartments, a presigmoid craniotomy, combining a middle fossa approach with anterior petrosectomy, and retrolabyrinthine approach with posterior petrosectomy were used to maximize the direct access corridor for resection. The petrous apex was already expanded and remodeled by the tumor. Nerve fascicles preservation technique is paramount to the functional preservation of the trigeminal nerve. The extent of resection should be weighed against the anatomical functional integrity of the nerve. Near total resection is considered if that means more nerve preservation. Postoperatively, the patient had a slight (House–Brackman grade II) facial droop, which resolved over days and developed right trigeminal hypesthesia at several weeks. This case is presented to demonstrate a combined petrosectomy technique for resection of lesions extending into both the middle and posterior cranial fossa with near total resection and trigeminal nerve preservation.

    The link to the video can be found at: https://youtu.be/kA9GyFhL1dg.


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    Zoom Image
    Fig. 1 Sagittal postcontrast MRI, showing dumbbell shaped trigeminal schwannoma in middle and posterior fossas.
    Zoom Image
    Fig. 2 Representative intraoperative anatomy of presigmoid approach.

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    Quality:

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    Conflict of Interest

    None.

    Address for correspondence

    A. Samy Youssef, MD, PhD
    Department of Neurosurgery, University of Colorado Hospital
    12631 East 17th Avenue
    Box C307, Aurora, CO 80045
    United States   

      
    Zoom Image
    Fig. 1 Sagittal postcontrast MRI, showing dumbbell shaped trigeminal schwannoma in middle and posterior fossas.
    Zoom Image
    Fig. 2 Representative intraoperative anatomy of presigmoid approach.