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Luzzi S, Giotta Lucifero A, Baldoncini M, Nuñez M, Villalonga JF, Galzio R, Campero A. Comparative Analysis of Surgical Working Corridors for Meckel Cave Trigeminal Schwannomas: A Quantitative Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 25:e251-e266. [PMID: 37589470 DOI: 10.1227/ons.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Volumetric analysis of the working corridors of the interdural approach to the Meckel cave may lead to a selection of routes which are anatomically more advantageous for trigeminal schwannoma resection. The herein-reported anatomic study quantitively compares the infratrochlear (IT) transcavernous, anteromedial (AM), and anterolateral (AL) corridors, highlighting their feasibility, indications, advantages, and limitations. METHODS Anatomic boundaries and depth of Meckel cave, porus trigeminus, IT transcavernous, AM, and AL corridors were identified in 20 formalin-fixed latex-injected cadaveric heads and were subsequently measured. The corridor areas and volumes were derived accordingly. Each opening angle was also calculated. Angles and volumes were compared using analysis of variance. Statistical significance was set at a P -value <.05. RESULTS The IT transcavernous corridor volume was greater than that of the AM and AL. The opening angle of the AM middle fossa triangle was wider than the other 2. CONCLUSION The IT corridor can be advantageous for Meckel cave schwannomas invading the cavernous sinus and those with a notable extension into the posterior fossa because the transcavernous approach maximizes the working space into the retrosellar area. The AM middle fossa corridor is strategic in schwannomas confined to the Meckel cave with a minor extension into the posterior fossa. It raises the chance of total resection with a single approach involving the porus trigeminus opening.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matías Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Nuñez
- Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | - Juan F Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
| | - Renato Galzio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
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2
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Dandekar AC, Mehta NA. A Case of Malignant Melanotic Schwannoma of the Trigeminal Nerve: A Case Report and Review of Literature. Asian J Neurosurg 2023; 18:352-356. [PMID: 37397058 PMCID: PMC10313432 DOI: 10.1055/s-0043-1768578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Intracranial melanotic schwannoma is quite rare, and involvement of the trigeminal nerve is even rarer. Early diagnosis and surgical excision are the mainstays of management. These tumors have a high tendency to recur and there is high possibility of metastasis. Adjuvant radiotherapy should be considered since the prognosis is uncertain. A 23-year-old man started developing numbness over the left side of the forehead 9 months ago that progressed to involve the ipsilateral cheek. The patient started having diplopia on looking to the left side 8 months ago. His relatives noticed a change in his voice 1 month ago and he developed weakness in the right upper and lower limbs, which was gradually progressive. The patient had slight difficulty swallowing. After examination, we found involvement of multiple cranial nerves with pyramidal signs. Magnetic resonance imaging (MRI) was suggestive of an extra-axial lesion in the left cerebellopontine angle extending into the middle cranial fossa, which was having high T1 and T2 signal loss with contrast enhancement. We achieved near-total excision of the tumor via a subtemporal extradural approach. Trigeminal melanotic schwannoma is a rare occurrence constituting melanin-producing cells and Schwann cells. Rapid progression of symptoms and signs should prompt the suspicion of the possible malignant nature of the pathology. Extradural skull base approaches reduce the risk of postoperative deficits. Differentiating melanotic schwannoma from malignant melanoma is of utmost importance in planning of management.
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Affiliation(s)
| | - Nirav A. Mehta
- Department of Neurosurgery, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India
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3
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Shin DW, Ju C, Lee HS, Yoo HJ, Song SW, Cho YH, Hong CK, Hong SH, Lee DH, Kim JH, Kim YH. Thirty-year clinical experience in gamma knife radiosurgery for trigeminal schwannomas. Sci Rep 2022; 12:14357. [PMID: 35999356 PMCID: PMC9399174 DOI: 10.1038/s41598-022-18689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
We aimed to evaluate the radiographic and clinical outcomes after gamma knife radiosurgery (GKRS) for trigeminal schwannomas (TSs). A total of 87 patients who underwent GKRS for TSs between 1990 and 2020 were enrolled. The mean tumor volume was 4.3 cm3. The median prescribed dose for the margins of the tumor was 13 Gy. The median follow-up duration was 64.3 months (range 12.0–311.5 months). The overall local tumor control rate was 90%, and the symptom response rate was 93%. The response rate for each symptom was 88% for facial pain, 97% for facial sensory change, and 86% for cranial nerve deficits. Nineteen (22%) patients showed transient swelling, which had regressed at the time of the last follow-up. Cystic tumors were associated with transient swelling (p = 0.04). A tumor volume of < 2.7 cm3 was associated with local tumor control in univariable analysis. Transient swelling was associated with symptom control failure in both univariable and multivariable analyses (p = 0.04, odds ratio 14.538). GKRS is an effective treatment for TSs, both for local control and symptom control.
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Affiliation(s)
- Dong-Won Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chunseng Ju
- Department of Plastic Surgery, Suwon Ever Plastic Surgery Clinic, Suwon, Gyeonggi-do, Republic of Korea
| | - Hyun Seok Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Department of Neurosurgery, Konkuk University Hospital, Seoul, Republic of Korea
| | - Hee Jun Yoo
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Department of Neurosurgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, Republic of Korea
| | - Sang Woo Song
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Do Heui Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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4
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Peciu-Florianu I, Régis J, Levivier M, Dedeciusova M, Reyns N, Tuleasca C. Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:2391-2403. [PMID: 33185756 PMCID: PMC8490235 DOI: 10.1007/s10143-020-01433-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
Trigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1-94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3-71, p < 0.001). Tumor progression rates were 9.4% (range 6.8-11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9-74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36-60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6-13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.
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Affiliation(s)
- Iulia Peciu-Florianu
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine and Centre Hospitalier Universitaire Vaudois (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, University of Lausanne, Lausanne, Switzerland
| | - Michaela Dedeciusova
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, Military University Hospital Prague, Prague, Czech Republic
| | - Nicolas Reyns
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Constantin Tuleasca
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France.
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
- Faculty of Biology and Medicine and Centre Hospitalier Universitaire Vaudois (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, University of Lausanne, Lausanne, Switzerland.
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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5
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Santoro G, Piccirilli M, Chiarella V, Greco N, Berra LV, Santoro A. Intracranial capillary hemangiomas: literature review in pediatric and adult population. Neurosurg Rev 2021; 44:1977-1985. [PMID: 33079288 DOI: 10.1007/s10143-020-01419-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Capillary hemangiomas (CHs) of the central nervous system represent a rare diagnosed pathology. CHs are benign vascular tumors whose most common manifestations are dermal and mucous and mainly occur during childhood or adolescence, while the involvement of the central nervous system can occur in a wider age range. We conducted a PubMed research on literature published until March 2020. We only enrolled cases with histological documented presence of intracranial CH. For every case collected, we analyzed age, sex, localization, neuroimaging studies performed, the presence of extracranial CHs, symptoms, neurological deficits, extent of surgical resection (biopsy, partial or gross total), adjunct treatment received (radiotherapy, chemotherapy, Trans-Arterial Embolization TAE), and outcome. Up to March 2020, the literature review identified 52 cases to which we added the case of our personal experience. The mean age was 26 with slightly female prevalence (28 F, 25 M). The most common presenting symptom was headache (21 cases, 40%). The surgical treatment consisted of biopsy in 7 cases (13%), partial resection in 10 cases (19%), gross total resection in 31 cases (58.5%), biopsy followed by total resection in 2 cases (3%), and partial resection followed by total resection in 1 case (1.5%), and the diagnosis was obtained from an autopsy sample in 1 case (1.5%). For symptomatic lesions, surgery is a valid option to obtain histological characterization, neurological improvement, and where possible a total resection. Stereotactic radiotherapy can be used if the lesion is not surgically approachable or as an adjuvant treatment in case of partial resection, having shown good results in terms of long-term disease control.
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Affiliation(s)
- Giorgio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Manolo Piccirilli
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Vito Chiarella
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy.
| | - Nicoletta Greco
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Aldo Moro University, Bari, Italy
| | | | - Antonio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
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6
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Bond JD, Xu Z, Zhang H, Zhang M. Meckel's Cave and Somatotopy of the Trigeminal Ganglion. World Neurosurg 2021; 148:178-187. [PMID: 33516868 DOI: 10.1016/j.wneu.2021.01.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The anatomy and spatial relationships of the dural sac comprising the Meckel cave (MC) and its ensheathed trigeminal ganglion (TG) are exceedingly intricate and complex. There are conflicting accounts in the literature regarding the dural configuration of the MC around the ganglion and the dual embryology of the MC and TG is still unclear. METHODS A combined systematic and narrative literature review was conducted to collate articles addressing MC and TG anatomy, in addition to their embryology, role in tumor spread, somatotopy, and association with trigeminal neuralgia. RESULTS Three key anatomic models by Paturet (1964), Lazorthes (1973), and Lang and Ferner (1983) have been put forward to show the arrangement of the MC around the TG. The TG is formed from both neural crest and placodal cells and drags the enveloping dura caudally to form the MC prolongation during development. Both a mediolateral and dorsoventral somatotopic arrangement of neurons exists in the TG, which corresponds to the 3 nerve divisions, of which V2 and V3 are prone to perineural tumor spread along their course. CONCLUSIONS Sound knowledge concerning the dural arrangement of the MC and the trigeminal divisions will be invaluable in optimally treating cancers in this region, and understanding TG somatotopy will immensely improve treatment of trigeminal neuralgia in terms of specificity, efficacy, and positive patient outcomes.
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Affiliation(s)
- Jacob D Bond
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Zhaoyang Xu
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Han Zhang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, Anhui Medical University, Hefei, China.
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7
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Abou-Al-Shaar H, Cohen MA, Bi WL, Gozal YM, Alzhrani G, Karsy M, Al-Mefty O, Couldwell WT. Surgical Management of Multifocal Trigeminal Schwannomas. Oper Neurosurg (Hagerstown) 2020; 19:659-666. [PMID: 32717071 DOI: 10.1093/ons/opaa227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Isolated trigeminal schwannomas occur in 0.07% to 0.3% of intracranial tumors and account for 0.8% to 8% of intracranial schwannomas and 1/3 of Meckel cave tumors. The presence of multisegmental schwannoma is rare, resulting in a limited understanding of its optimal management. OBJECTIVE To describe potential surgical options to manage this rare entity. METHODS A 2-institution retrospective review of all patients with pathologically confirmed trigeminal schwannoma managed with resection from January 2009 through January 2019 was conducted. A manual chart review was performed to verify patients' inclusion and collect data about age, sex, tumor size, tumor site, treatment modality, surgical approach, complications, and follow-up duration and status. RESULTS A total of 4 patients (age range 12-50 yr) who underwent a variety of cranial and orbitocranial approaches for tumor resection were identified. Patients achieved good outcomes with improvement of visual outcomes. One case of infection and 1 case of partial tumor recurrence requiring reresection were identified. CONCLUSION Multisegmental trigeminal schwannoma is a rare and unique entity, often associated with trigeminal schwannomatosis. Interdisciplinary management has been shown to be the most effective method for improving patient outcomes with these complex and poorly understood diseases.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael A Cohen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Gmaan Alzhrani
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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8
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Moisak GI, Matsko DE, Chernov SV, Dmitriev AB, Amelin ME, Zhelbunova EA, Chernov MF, Rzaev JA. What Tactics Should a Surgeon Choose to Treat a Black Extracerebral Tumor? A Case Report of Psammomatous Melanotic Schwannoma of the Meckel Cave and Literature Review. World Neurosurg 2018; 116:337-342. [PMID: 29715570 DOI: 10.1016/j.wneu.2018.04.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neoplasms located in the Meckel cave account for 0.2%-0.5% of all intracranial tumors. This area is the site of many types of pathologic lesions, most often trigeminal nerve schwannomas and meningiomas. Melanin-containing tumors are rare in this area. These tumor types can be suspected if the magnetic resonance characteristics of a tumor has some differences in comparison with other types of central nervous system neoplasms. In fact, differential diagnosis of melanotic tumors is based mainly on the histopathologic criteria and immunohistochemical profile. This article presents a case report of melanotic schwannoma of the Meckel cave and a literature review of the problem. CASE DESCRIPTION A 23-year-old man underwent a 2-stage surgery for a dumbbell pigmented mass lesion located in the Meckel cave. No signs of recurrence were seen on follow-up magnetic resonance imaging (MRI) 3.5 years after the operation. CONCLUSIONS Melanin-containing tumor can be suspected in the presence of radiologic characteristics, such as a hyperintense MRI signal on T1-weighted images and a hypointense signal on T2-weighted images. If a black extracerebral tumor is detected, the main course of surgical treatment is maximal excision despite it possibly being a malignant melanoma and the temptation to perform partial resection because of an unfavorable prognosis. Chemotherapy can be justified in the presence of an aggressive melanotic schwannoma.
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Affiliation(s)
- Galina I Moisak
- Federal Center of Neurosurgery, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | - Dmitry E Matsko
- Chair of Oncology, Saint Petersburg State University, Saint Petersburg, Russia; Department of Pathomorphology and Histology, Diagnostic and Treatment Center of the International Institute of the Biological Systems named after Dr. S.M. Berezin, Saint Petersburg, Russia
| | | | | | | | - Elena A Zhelbunova
- Department of Pathomorphology and Histology, Diagnostic and Treatment Center of the International Institute of the Biological Systems named after Dr. S.M. Berezin, Saint Petersburg, Russia
| | - Mikhail F Chernov
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Jamil A Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia.
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9
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Doddamani RS, Meena RK, Mohan SM, Venkatramanaa NK. Single Stage Complete Removal of Dumbbell Trigeminal Schwannoma in a Child by Skull Base Approach. Asian J Neurosurg 2018; 13:136-139. [PMID: 29492145 PMCID: PMC5820870 DOI: 10.4103/1793-5482.175633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trigeminal schwannomas (TSs) are extremely rare tumors in childhood, particularly in the absence of neurofibromatosis. Although multi-staged surgical strategies have been reported in the literature, safe and single stage microsurgical removal is possible. We report a rare case of dumbbell TS, in a 9-year-old girl in whom single stage complete removal was done using fronto-temporo-orbito-zygomatic craniotomy and sub temporal approach.
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Affiliation(s)
| | - Rajesh Kumar Meena
- Department of Neurosurgery, BGS Global Institute of Neurosciences, Bengaluru, Karnataka, India
| | - Selvam Murali Mohan
- Department of Neurosurgery, BGS Global Institute of Neurosciences, Bengaluru, Karnataka, India
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10
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Radoi M, Stefanescu F, Vakilnejad R, Rodica F. Surgical treatment of rare metastatic tumor in Meckel’s Cave: a case report. ROMANIAN NEUROSURGERY 2017. [DOI: 10.1515/romneu-2017-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives: Metastases in Meckel’s cave are a rare tumor entity, but they should be considered in patients with a known primary malignancy and who complain of trigeminal neuralgia.
Methods: The case of a patient with a left trigeminal neuralgia caused by a metastatic tumor involving the Meckel’s cave and Gasserian ganglion is reported. Preoperative symptoms included headache, trigeminal hyperesthesia and facial pain.
Results: The patient underwent microsurgical resection of the tumor, obtaining a histological diagnosis and a resolution of the pain. Trigeminal motor function was preserved.
Conclusion: The best treatment for tumors of Meckel’s cave, including metastases, is complete microsurgical removal. Although good results have been reported with radiosurgery, this treatment should be reserved only for nonresectable and residual tumors.
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11
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Venkata RI, Kakarala SV, Garikaparthi S, Duttaluru SS, Parvatala A, Chinnam A. Giant intracranial osteochondroma: A case report and review of the literature. Surg Neurol Int 2011; 2:118. [PMID: 21918733 PMCID: PMC3172004 DOI: 10.4103/2152-7806.84242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/28/2011] [Indexed: 11/04/2022] Open
Abstract
Background: Intracranial osteochondromas are uncommon. The majority of lesions arise from the base of the skull or from bones developed by endochondral ossification. A minority of cases are attached to the falxcerebri in the fronto parietal location. Case Description: We report a case of a giant intracranial osteochondroma in a 24-year-old man. This patient presented with complaints of convulsions and headache. Imaging studies of the brain, gross, and histological features concluded it to be an osteochondroma. Conclusion: This case is reported in view of extreme rarity of the lesion, and to emphasize the fact that complete surgical resection is curative.
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12
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Ramina R, Mattei TA, Sória MG, da Silva EB, Leal AG, Neto MC, Fernandes YB. Surgical management of trigeminal schwannomas. Neurosurg Focus 2009; 25:E6; discussion E6. [PMID: 19035703 DOI: 10.3171/foc.2008.25.12.e6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension. METHODS A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year. RESULTS Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively. CONCLUSIONS The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.
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Affiliation(s)
- Ricardo Ramina
- Department of Neurosurgery, Instituto de Neurologia de Curitiba, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Kano H, Niranjan A, Kondziolka D, Flickinger JC, Dade Lunsford L. Stereotactic radiosurgery for trigeminal schwannoma: tumor control and functional preservation Clinical article. J Neurosurg 2009; 110:553-8. [PMID: 19301456 DOI: 10.3171/2008.7.jns0812] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT To evaluate outcome predictors after stereotactic radiosurgery (SRS) in patients with trigeminal schwannomas, the authors compared tumor control, functional preservation, and complications with tumor grade, tumor volume, patient age, and tumor imaging characteristics. METHODS The records of 33 consecutive patients with trigeminal schwannoma treated via Gamma Knife surgery were retrospectively reviewed. The median patient age was 49.5 years (range 15.1-82.5 years). Eleven patients had undergone prior tumor resection. Two patients had neurofibromatosis Type 2. Lesions were classified as root type (6 tumors), ganglion type (17 tumors), and dumbbell type (10 tumors) based on their location. The median radiosurgery target volume was 4.2 cm3 (range 0.5-18.0 cm3), and the median dose to the tumor margin was 15.0 Gy (range 12-20 Gy). RESULTS At an average of 6 years (range 7.2-147.9 months), the rate of progression-free survival (PFS) at 1, 5, and 10 years after SRS was 97.0, 82.0, and 82.0%, respectively. Factors associated with improved PFS included female sex, smaller tumor volume, and a root or ganglion tumor type. Neurological symptoms or signs improved in 11 (33.3%) of 33 patients and were unchanged in 19 (57.6%). Three patients (9.1%) had symptomatic disease progression. Patients who had not undergone a prior tumor resection were significantly more likely to show improvement in neurological symptoms or signs. CONCLUSIONS Stereotactic radiosurgery is an effective and minimally invasive management option in patients with residual or newly diagnosed trigeminal schwannomas. Predictors of a better treatment response included female sex, smaller tumor volume, root or ganglion tumor type, and the application of SRS as the primary treatment.
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Affiliation(s)
- Hideyuki Kano
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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14
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Abstract
EDUCATIONAL OBJECTIVE At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas. OBJECTIVES 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm. STUDY DESIGN Retrospective review of 23 cases. METHODS Chart review. RESULTS From 1984 to 2006, of 23 patients with trigeminal schwannoma (10 males and 13 females, ages 14-77 years), 15 patients underwent combined transpetrosal extirpation, 5 patients underwent stereotactic radiation, and 3 were followed without intervention. Of the 15 who underwent surgery, total tumor removal was achieved in 9 patients. Cytoreductive surgery was performed in six patients; of these, four received postoperative radiation. One patient who underwent primary radiation therapy required subsequent surgery. There were no deaths in this series. Cranial neuropathies were present in 14 patients pretreatment and observed in 17 patients posttreatment. Major complications included meningitis (1), cerebrospinal fluid leakage (2), major venous occlusion (1), and temporal lobe infarction (1). CONCLUSIONS Trigeminal schwannomas are uncommon lesions of the skull base that may occur in the middle fossa, posterior fossa, or both. Moreover, caudal extension results in their presentation in the infratemporal fossa. Contemporary diagnostic imaging, coupled with selective use of both surgery and radiation will limit morbidity and allow for the safe and prudent management of this uncommon lesion.
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Peker S, Bayrakli F, Kiliç T, Pamir MN. Gamma-knife radiosurgery in the treatment of trigeminal schwannomas. Acta Neurochir (Wien) 2007; 149:1133-7; discussion 1137. [PMID: 17728994 DOI: 10.1007/s00701-007-1285-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 05/15/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Trigeminal nerve schwannomas account for 0.07%-0.28% of all intracranial tumours. Advances in skull base surgery have led to more aggressive resection of these tumours, but surgery may associated with development of new neurological deficits. METHODS In this report, we analyse the long-term results 15 patients with newly diagnosed or residual/recurrent trigeminal schwannoma who underwent gamma-knife treatment. FINDINGS During a mean 61 months of follow-up, MRI revealed reduction of tumour size in 13 and no size change in 2 patients. The tumour growth control rate was 100% and only 1 patient had transient facial numbness and diplopia. CONCLUSIONS For patients with small to moderate size trigeminal schwannomas, gamma-knife radiosurgery is associated with good tumour control and a minimal risk of adverse radiation effects.
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Affiliation(s)
- S Peker
- Gamma Knife Radiosurgery Unit, Department of Neurosurgery, Acibadem Kozyatagi Hospital, Istanbul, Turkey.
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Pamir MN, Peker S, Bayrakli F, Kiliç T, Ozek MM. Surgical treatment of trigeminal schwannomas. Neurosurg Rev 2007; 30:329-37; discussion 337. [PMID: 17676346 DOI: 10.1007/s10143-007-0093-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Revised: 03/22/2007] [Accepted: 04/28/2007] [Indexed: 10/23/2022]
Abstract
Schwannomas that arise from the trigeminal nerve are rare, but this nerve is the second most frequent intracranial site of schwannoma occurrence next to the vestibular nerve. The advent of microsurgical techniques and skull-base approaches has greatly enhanced the surgical management of these tumors, and outcomes have improved markedly. This report documents 18 cases of histologically verified schwannomas that arose from the trigeminal nerve and were treated surgically in our clinic between January 1992 and July 2005. The patients were ten women and eight men of age 39.7 years (range, 22-62 years). The tumor was located in the middle fossa (type A) in five cases, in the middle and posterior fossae (type C) in nine cases, in the posterior fossa (type B) in two cases, and in the branches of the trigeminal nerve (type D) in two cases. Total excision was achieved in 17 cases, and there was no mortality in the series. Our results indicate that trigeminal schwannomas, regardless of type, can be removed via skull-base approaches. We present an algorithm for surgical management of trigeminal schwannomas based on our experience and information from the literature.
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Affiliation(s)
- M Necmettin Pamir
- Department of Neurosurgery, Marmara University, Neurological Sciences Institute, Acibadem Kozyatagi Hospital, Istanbul, Turkey
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17
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Teixeira MJ, Siqueira SRDT, Almeida GM. Percutaneous radiofrequency rhizotomy and neurovascular decompression of the trigeminal nerve for the treatment of facial pain. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:983-9. [PMID: 17221008 DOI: 10.1590/s0004-282x2006000600018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 08/12/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To determine the outcomes of 354 radiofrequency rhizotomies and 21 neurovascular decompressions performed as treatment for 367 facial pain patients (290 idiopathic trigeminal neuralgia, 52 symptomatic trigeminal neuralgia, 16 atypical facial pain, 9 post-herpetic neuralgia). METHOD: Clinical findings and surgery success rate were considered for evaluation. A scale of success rate was determined to classify patients, which considered pain relief and functional/sensorial deficits. RESULTS: Radiofrequency rhizotomy was performed in 273 patients with idiopathic trigeminal neuralgia and in all other patients, except for trigeminal neuropathy; neurovascular decompression was performed in 18 idiopathic trigeminal neuralgia patients; 100% idiopathic trigeminal neuralgia, 96.2% symptomatic trigeminal neuralgia, 37.5% atypical facial pain and 88.9% post-herpetic neuralgia had pain relief. CONCLUSION: Both techniques for idiopathic trigeminal neuralgia are usefull. Radiofrequency rhizotomy was also efficient to treat symptomatic facial pain, and post-herpetic facial pain, but is not a good technique for atypical facial pain.
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Affiliation(s)
- Manoel J Teixeira
- Pain Center of Hospital das Clinicas, Functional Neurosurgery Division, Neurology Department, Medical School, University of São Paulo SP, Brazil
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18
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Falavigna A, Borba LAB, Ferraz FAP, Almeida GCD, Krindges Júnior JV. Primary melanoma of Meckel's cave: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:353-6. [PMID: 15235745 DOI: 10.1590/s0004-282x2004000200030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We present a case of trigeminal neuralgia with cranial normal magnetic resonance image (MRI) and computed tomography. The pain was not relieved by carbamazepine and microvascular decompression surgery was done. After two months the pain was similar to the condition before surgery. At this time, MRI showed an expansive lesion in Meckel's cave that was treated with radical resection by extra-dural approach. The pathologic examination revealed a primary melanoma. The follow-up after six months did not show abnormalities.
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Affiliation(s)
- Asdrubal Falavigna
- Faculdade de Medicina, Universidade de Caxias do SulTaubaté, SP, Brasil.
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Koyye RT, Mahadevan A, Santosh V, Chickabasaviah YT, Govindappa SS, Hegde T, Shankar SK. A rare case of cellular schwannoma involving the trigeminal ganglion. Brain Tumor Pathol 2004; 20:79-83. [PMID: 14756445 DOI: 10.1007/bf02483451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cellular schwannomas rarely involve the cranial nerves, being more common in the spinal and peripheral nerves. A rare case of cellular schwannoma involving the gasserian ganglion, a hitherto unreported site, that extended infratentorially to present as a cerebellopontine angle tumor is reported. It is important to recognize that cellular schwannomas can histologically mimic malignant peripheral nerve sheath tumors because of their high cellularity and mitotic activity, but they are relatively benign tumors with a tendency to recur but not metastasize.
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Affiliation(s)
- Ravindranath Tagore Koyye
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India
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Akhaddar A, El Mostarchid B, Zrara I, Boucetta M. Intracranial Trigeminal Neuroma Involving the Infratemporal Fossa: Case Report and Review of the Literature. Neurosurgery 2002. [DOI: 10.1227/00006123-200203000-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Akhaddar A, El-Mostarchid B, Zrara I, Boucetta M. Intracranial trigeminal neuroma involving the infratemporal fossa: case report and review of the literature. Neurosurgery 2002; 50:633-7; discussion 637-8. [PMID: 11841734 DOI: 10.1097/00006123-200203000-00039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Intracranial trigeminal neuroma extending extracranially is not a common finding. We report the case of a patient with a right cystic trigeminal neuroma arising in the middle temporal fossa and infratemporal areas. The clinical, radiological, and intraoperative features of these unusual lesions are discussed, and the relevant literature is reviewed. CLINICAL PRESENTATION A 35-year-old woman presented with a 4-year history of right serous otitis media associated with recent right facial paresthesia. A neurological examination revealed hypesthesia in the mandibular division of the right trigeminal nerve. Computed tomographic and magnetic resonance imaging scans demonstrated a 6 x 6 x 4-cm well-enhancing cystic mass arising from the middle temporal fossa and extending extracranially to the infratemporal fossa through the enlarged foramen ovale. INTERVENTION The tumor was extradural and originated from the right mandibular nerve. It was subtotally removed via a subtemporal-intradural and extradural approach. A pathological examination revealed a cystic neuroma. The patient has remained well during 12 months of follow-up, and no evidence of recurrence has been noted on magnetic resonance imaging studies. CONCLUSION Unilateral serous otitis media by obstruction of the eustachian tube is a rare initial manifestation of trigeminal neuroma. We emphasize the benefit of neuroradiological examinations (both computed tomographic scanning and magnetic resonance imaging), which provided the clearest preoperative localization of this large intra- and extracranial tumor. A combined frontotemporal and infratemporal fossa approach is preferred, considering the difficulty of surgical removal. The prognosis for most patients was good. Twenty-five previously reported cases were also reviewed.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohamed V Military Hospital, Rabat, Morocco.
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22
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Huang CF, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Trigeminal Schwannomas. Neurosurgery 1999. [DOI: 10.1227/00006123-199907000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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23
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Huang CF, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 1999; 45:11-6; discussion 16. [PMID: 10414560 DOI: 10.1097/00006123-199907000-00002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Schwannomas that arise from the trigeminal nerve are rare and are usually managed by surgical resection. The role of radiosurgery in the care of patients with these basal tumors remains to be defined. METHODS We reviewed the clinical presentation, management, and outcomes for 16 trigeminal schwannoma patients who underwent gamma knife stereotactic radiosurgery. Fifteen of the 16 patients presented with trigeminal sensory dysfunction. Nine patients had tumors in the region of the ganglion, six in the region of the trigeminal nerve root, and one in the region of the mandibular branch. Six patients had undergone one or more previous resections before radiosurgery. Ten underwent radiosurgery as the first procedure. The mean tumor volume was 5.3 cc (range, 1-17.8 cc). The mean tumor margin dose was 15.3 Gy (range, 12-20 Gy). RESULTS During the average imaging follow-up of 44 months (range, 8-116 mo), the tumor control rate was 100% (regression in nine patients and no further tumor growth in seven patients). Five patients had improvement of clinical symptoms, and 11 remained unchanged. No new cranial nerve deficit developed in any patient. CONCLUSION As a minimally invasive alternative to microsurgery, gamma knife radiosurgery proved to be an alternative primary or adjuvant strategy that controlled tumor growth, did not cause new deficits, and often improved presenting symptoms.
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Affiliation(s)
- C F Huang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
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24
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Abstract
OBJECTIVE This study was conducted to determine whether removing the bony prominence located above the porus of the internal acoustic meatus, called the suprameatal tubercle, and surrounding bone using the retrosigmoid approach would aid in the exposure of tumors that are located predominantly in the cerebellopontine angle but that also extend into the middle cranial fossa in the region of Meckel's cave and thus avoid the need for a supratentorial craniotomy. METHODS Thirty cerebellopontine angles from 15 cadaveric heads examined using 3 to 40x magnification provided the material for this study. A retrosigmoid craniotomy was completed and the exposure obtained before and after removing the suprameatal tubercle, and the surrounding bone was examined. In some cases, Meckel's cave and the tentorium lateral to the porus of Meckel's cave was opened to aid in the exposure. RESULTS Removing the suprameatal tubercle and surrounding bone increased the exposure an average of 10.3 mm (range, 8.0-13.0 mm) forward of the exposure, which could be obtained without suprameatal drilling. The extent of bone removal was limited on the lateral side by the posterior and superior semicircular canals and their common crus. CONCLUSION The suprameatal extension of the retrosigmoid approach will permit removal of some tumors that are located mainly in the posterior fossa but that extend into the middle fossa in the region of Meckel's cave. The exposure can be increased by opening the superior petrosal sinus as it crosses in the upper margin of the porus of Meckel's cave and by opening the tentorium lateral to Meckel's cave.
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Affiliation(s)
- E Seoane
- Department of Neurological Surgery, University of Florida, Gainesville 32610-0265, USA
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25
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Samii M, Carvalho GA, Tatagiba M, Matthies C. Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 1997; 41:767-74; discussion 774-5. [PMID: 9316037 DOI: 10.1097/00006123-199710000-00003] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To define the difference of meningiomas that originate in the area of Meckel's cave (MC) (primary MC meningiomas) in regard to the different surgical approaches and postoperative results. METHODS A retrospective analysis of all meningiomas involving the cranial base displayed 21 cases of meningiomas originating in MC (primary MC meningiomas). These cases were classified according to the tumor extension in four different types: Type I, tumors mainly confined to MC; Type II, MC meningiomas with extension into the middle fossa; Type III, MC meningiomas with extension into the posterior fossa; and Type IV, MC meningiomas with extension into both middle and posterior fossae. RESULTS Trigeminal neuralgia resolved in all cases in this series, despite tumor type. Trigeminal hypesthesia showed postoperative improvement only in Type III MC meningiomas. In Types I and III, total removal without further morbidity was frequently achieved. Cavernous sinus infiltration, especially in Types II and IV, limited (in some cases) the extent of tumor extirpation. CONCLUSION Types I, II, and III MC meningiomas have a good prognosis. In most cases, very good outcomes are achieved. Radical tumor removal can usually be achieved without further morbidity and with postoperative improvement of the preexisting symptoms, especially in Types I and III MC meningiomas. On the contrary, Type IV MC meningiomas are usually only subtotally resected. Surgery in such cases may carry a high risk of additional morbidity, especially with regard to the IIIrd, IVth, and VIth cranial nerves. The postoperative outcome regarding facial pain in cases of all tumor types is usually very good. Trigeminal hypesthesia may persist after tumor removal in the majority of cases.
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Affiliation(s)
- M Samii
- Neurosurgical Department, Nordstadt Hospital, Hannover, Germany
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26
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Konovalov AN, Spallone A, Mukhamedjanov DJ, Tcherekajev VA, Makhmudov UB. Trigeminal neurinomas. A series of 111 surgical cases from a single institution. Acta Neurochir (Wien) 1996; 138:1027-35. [PMID: 8911538 DOI: 10.1007/bf01412304] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neurinomas arising from the trigeminal nerve are rare (0.1-0.4% of intracranial tumours: 1-8% of all intracranial neurinomas). A series of 111 trigeminal neurinomas operated on at the Institute of Neurosurgery "N. N. Burdenko" of Moscow, Russia, during the period 1961-1994 is presented. Clinical features, diagnostic radiology, surgery and results of treatment are discussed. We distinguished four groups of trigeminal neurinomas: a) Posterior fossa tumours; b) Tumours of the Gasserian ganglion; c) "Dumb-bell" supra-subtentorial tumours; d) Neurinomas of the peripheral branches. The complex clinical symptomatology is related to the actual location of the lesion. Surgery of trigeminal neurinomas may be very difficult, particularly in cases of dump-bell supra-subtentorial lesions. In this series, 3 cases died postoperatively. Out of the 108 patients surviving surgery, long-term follow-up (min. 13 months, max. 33 years, average 13.5 years) was available in 98 cases. 84 patients (86.7%) showed good-to excellent results, with partial trigeminal deficit as the only surgical sequela. 13 patients (11.7%) had a symptomatic recurrence following incomplete tumour removal. Second surgery, ranging from 1.4 to 9 years (average 3.8 years) following the first operation, was judged radical in 9 cases (69.2), however, the rate of complications of repeated surgery was higher than that occurring after the first operation. The advent of microsurgery, together with the introduction of the techniques of skull base surgery and of modern diagnostic imaging tools, have improved surgical results in terms of increased radicality and reduced complications.
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Affiliation(s)
- A N Konovalov
- Institute of Neurosurgery N. N. Burdenko, Academy of Medical Sciences of Russia, Moscow, Russia
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Tacconi L, Arulampalam T, Johnston F, Symon L. Adenocarcinoma of Meckel's cave: case report. SURGICAL NEUROLOGY 1995; 44:553-5. [PMID: 8669031 DOI: 10.1016/0090-3019(95)00224-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A rare localization of adenocarcinoma in Meckel's cave is reported in a 58-year-old woman, who had a 5-month history of pain and altered sensation in the second division of the left trigeminal nerve. Removal of the lesion was achieved by a subtemporal route. Histology showed this to be an adenocarcinoma. The patient underwent investigations for a primary tumor; the investigations were all negative, and the patient was subsequently treated with a course of radiotherapy. At 4-month follow-up, there was no evidence of recurrence, and she remains symptomatically well. The various mechanisms of secondary localization are discussed.
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Affiliation(s)
- L Tacconi
- Department of Neurological Surgery, National Hospital, London, England
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28
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Tancioni F, Gaetani P, Villani L, Zappoli F, Rodriguez Y, Baena R. Neurinoma of the trigeminal root and atypical trigeminal neuralgia: case report and review of the literature. SURGICAL NEUROLOGY 1995; 44:36-42. [PMID: 7482252 DOI: 10.1016/0090-3019(95)00173-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Neurinomas of the trigeminal nerve are a rare entity: those located in the posterior fossa account for 20% of all cases. In the majority of cases, the clinical presentation begins with fifth cranial nerve involvement producing a constant pain associated with other cranial nerve palsy and cerebellar signs. METHODS We report the clinical features, neuroradiological imagings, and management of a case of trigeminal neurinoma located in the cerebellopontine angle, arising from the Vth cranial nerve root, presenting with an atypical trigeminal neuralgia; moreover, we analyze similar cases reported in the literature and we discuss whether pain can be produced by a neurinoma that arises central to the ganglion. RESULTS The tumor presented with an atypical trigeminal neuralgia characterized by constant trigeminal pain with paroxystical burns, hyperesthesia and hyperactive autonomic dysfunction. Neuroradiological examinations provided the best preoperative localization of this lesion, allowing better planning of the surgical approach, considering the large size of this tumor. A retromastoid incision and posterior fossa craniectomy approach was used, with complete excision of the tumor. The paraxysmal sharp pain and hyperesthesia disappeared completely, but the constant burning pain persisted although it was less intense. At an 8-month follow-up examination, the patient showed a progressive improvement of clinical symptoms and control magnetic resonance imaging (MRI) showed the complete removal of the neoplasm and the absence of residuals or recurrences. CONCLUSION Although in a high percentage of cases of atypical trigeminal neuralgia a neurovascular conflict might be suspected, the review of the present case suggests that the hypothesis of a trigeminal neurinoma must be investigated both with adequate neuroradiological procedures and/or microsurgical exploration of the trigeminal root.
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Affiliation(s)
- F Tancioni
- Department of Surgery, Neurosurgery, IRCCS Policlinico S. Matteo, Pavia, Italy
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29
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Abstract
A total of 27 patients with trigeminal schwannoma were treated between 1982 and 1992 at the Neurosurgery Department of Nordstadt Hospital. Twelve cases of solitary schwannoma without any family history or physical stigmata of neurofibromatosis were included and form the basis of this study. There were four women and eight men (mean age 44 years) in this series. Duration of symptoms ranged from 2 months to 6 years. The most frequent symptoms were either pain or numbness of the ipsilateral hemiface. The surgical approach was chosen depending on the tumor type. Tumors that belonged to Type A (five cases), which were predominantly in the middle fossa, were approached using a transsylvian method; Type B (one case), which presented predominantly in the cerebellopontine angle, was operated on via a retrosigmoid suboccipital craniectomy; Type C (five cases), which were dumbbell-shaped extending into both the middle and posterior fossa, were removed via a combined temporal craniotomy-presigmoidal method; and in Type D (one case), in which tumor was primarily extracranial with intracranial extension, an infratemporal extradural approach was undertaken. There was no operative mortality or long-term disability in this series. The follow-up period ranged from 12 to 60 months; during that time magnetic resonance imaging revealed tumor recurrence in two cases after 12 and 48 months, respectively, and these were excised again. An additional 178 cases collected from the world literature are also reviewed and analyzed.
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Affiliation(s)
- M Samii
- Neurosurgery Department, Nordstadt Hospital, Hannover, Germany
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Celli P, Ferrante L, Acqui M, Mastronardi L, Fortuna A, Palma L. Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. SURGICAL NEUROLOGY 1992; 38:216-24. [PMID: 1440207 DOI: 10.1016/0090-3019(92)90172-j] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A rare case of trochlear nerve neurinoma is described. Including this case, the number of reported intracranial tumors arising from the sheaths of the third, fourth, and sixth cranial nerves is 38. By site and relationship to the nerve segment, they fall into three groups: cisternal, cisternocavernous, and cavernous. In cisternal tumors of the third and sixth nerves, paresis of the nerve hosting the tumor is the unique nerve deficit; by contrast, in those of the fourth nerve, paresis of the trochlear nerve can be absent and that of the third nerve present. In the latter tumors, a peculiar ataxic hemiparesis syndrome is produced by midbrain compression. Cisternocavernous neurinomas often cause symptoms of intracranial hypertension, while cavernous neurinomas bring about two clinical features: paresis of one or more nerves of the cavernous sinus and a clinicoradiological orbital apex syndrome. At surgery, generally cisternal neurinomas are totally removed and the nerve source of the tumor identified; in cisternocavernous and cavernous neurinomas, total removal of tumor and identification of the parent nerve have been reported in only half of the cases. In the majority of parasellar neurinomas, clinical differences can be found between those arising from the nerves governing eye movement and those arising from the gasserian ganglion.
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Affiliation(s)
- P Celli
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
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33
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Haddad FS, Jamali AF, Rebeiz JJ, Fahl M, Haddad GF. Primary malignant melanoma of the gasserian ganglion associated with neurofibromatosis. SURGICAL NEUROLOGY 1991; 35:310-6. [PMID: 1901179 DOI: 10.1016/0090-3019(91)90011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of primary intracranial malignant melanoma of the left gasserian ganglion associated with temporal lobe gliosis in a patient suffering from von Recklinghausen's disease is reported. The association of primary malignant melanoma of the trigeminal nerve and neurofibromatosis is discussed.
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Affiliation(s)
- F S Haddad
- Division of Neurosurgery, American University of Beirut Medical Faculty, Lebanon
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Kimura H, Oka K, Nakayama Y, Tomonaga M. Xanthoma in Meckel's cave. A case report. SURGICAL NEUROLOGY 1991; 35:317-20. [PMID: 1901180 DOI: 10.1016/0090-3019(91)90012-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of xanthoma located within Meckel's cave and the semilunar ganglion is described in a patient with a trigeminal nerve deficit. This is the first case of xanthoma in such a location. The distinctive morphological appearance is illustrated and the possible histogenesis is discussed.
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Affiliation(s)
- H Kimura
- Department of Neurosurgery, School of Medicine, Fukuoka University, Japan
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Horie Y, Akagi S, Taguchi K, Yoshino T, Hayashi K, Takahashi K, Akagi T. Malignant schwannoma arising in the intracranial trigeminal nerve. A report of an autopsy case and a review of the literature. ACTA PATHOLOGICA JAPONICA 1990; 40:219-25. [PMID: 2193485 DOI: 10.1111/j.1440-1827.1990.tb03326.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An autopsy case of malignant schwannoma arising in the intracranial trigeminal nerve is reported. The tumor involved the right cerebellopontine angle of the brain stem in an 18-year-old man. The spindle-shaped tumor cells with eosinophilic cytoplasm proliferated in fascicles and exhibited hypercellularity, pleomorphism, increased mitotic activity and invasive growth. Ultrastructurally, interdigitating cytoplasmic processes and a few fragmented basal lamina-like structures were observed. Immunohistochemically, some tumor cells were reactive with conventional anti-S-100 protein antibody, but negative for beta subunit. Most tumor cells were positive for alpha subunit of S-100 protein. This is the eighth reported case of malignant schwannoma arising in the intracranial trigeminal nerve.
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Affiliation(s)
- Y Horie
- Department of Pathology, Okayama University Hospital, Japan
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Abstract
Trigeminal neuralgia (tic douloureux) was first identified over three hundred years ago. Only recently have the causes of the disorder begun to be recognized and understood. The first attempts at treatment involved the neurotomy of peripheral branches of the trigeminal nerve. This procedure, along with neurectomy, ganglionectomy, rhizotomy, tractotomy, and injections of toxic substances into the ganglion and nerve branches were the main treatment modalities in years past. Although they exhibited marked success, they are fraught with complications, such as relapse, loss of facial sensation and motor control, infection, deafferentation pain, and a fairly high rate of mortality from the procedure. The current treatment modalities that result in a predictable success with minimal risk are microvascular decompression, percutaneous retrogasserian thermal rhizotomy, and percutaneous retrogasserian glycerol rhizotomy. Other procedures, such as balloon compression of the gasserian ganglion, cryotherapy, acupuncture, and drug therapy, are also being used with marked promise.
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37
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Abstract
Sixteen patients with trigeminal neurilemoma have been treated at the University Health Center of Pittsburgh during the last 15 years. Two patients had middle fossa tumors arising from the trigeminal ganglion, four had posterior fossa tumors arising from the trigeminal roots, six had "hourglass" lesions extending above and below the tentorium and involving the trigeminal ganglion and its roots, and four had tumors arising from the trigeminal branches and extending through the superior orbital fissure, foramen rotundum, or foramen ovale. In seven patients, tumor had also invaded the cavernous sinus. The clinical and radiographic features of these tumors, the operative approaches employed, and the postoperative outcome are discussed. Complete tumor excision was achieved in 12 patients; all 12 remain free of recurrence 3 to 157 months after surgery. In contrast, all four patients who underwent subtotal tumor excision showed progressive neurological deterioration from regrowth of residual tumor within 3 years of the initial surgery. Two of these four subsequently had total tumor excision and both are disease-free 23 and 34 months after the second procedure. Major morbidity developed in only one of the 16 patients. There were no operative deaths. Nine patients had preserved or improved trigeminal function after treatment.
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Affiliation(s)
- I F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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Abstract
The clinical features, diagnosis, and management of a series of 11 cases of trigeminal neuroma (four men, seven women; mean age 40 years) are summarized. Symptoms at presentation were generally those of cerebellopontine angle and petrous apex space occupying lesions. Computed tomography scanning and magnetic resonance imaging were found to provide the best preoperative localization of these lesions, allowing better planning of the surgical approach and thereby maximizing tumor exposure, an essential for any attempt at total excision, considering the large size (greater than 3 cm) of these tumors when diagnosed. A retromastoid incision and posterior fossa craniectomy or a combined suprainfratentorial approach was used. Total excision was possible in four cases. In seven cases, a macroscopic clearance was effected (operative mortality nil, excellent outcome occurred in ten of the 11 cases). There has been no clinical evidence of recurrence or ongoing tumor growth despite possibly subtotal excision.
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Affiliation(s)
- L Bordi
- Gough-Cooper Department of Neurological Surgery, National Hospital for Nervous Diseases, London, England
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McCormick PC, Bello JA, Post KD. Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 1988; 69:850-60. [PMID: 3057125 DOI: 10.3171/jns.1988.69.6.0850] [Citation(s) in RCA: 142] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients. The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months). The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.
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Affiliation(s)
- P C McCormick
- Department of Neurological Surgery, Columbia-Presbyterian Medical Center, New York, New York
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Abstract
A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.
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Affiliation(s)
- M G Fehlings
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract
A series of 12 patients with mass lesions arising from Meckel's cave is presented. Patients' age on presentation ranged from 13 months to 71 years. Nine of the 12 patients had symptoms referable to the fifth cranial nerve, but only three complained of facial pain. The 12 patients presented eight different pathological entities, including meningioma, lipoma, schwannoma, malignant melanotic schwannoma, arachnoid cyst, neurofibroma, epidermoid tumor, and chordoma. Computerized tomography and magnetic resonance imaging were most useful in localizing the lesion to Meckel's cave. All 12 patients underwent a subtemporal approach to the lesion, and gross total removal was achieved in 11. Postoperative results were excellent with no increased neurological deficits seen 3 months postoperatively. Most patients had resolution of the cranial nerve deficits except for fifth nerve function, which was impaired in nine patients postoperatively. This series demonstrates that lesions in Meckel's cave can have a varied and unusual presentation, as well as an assortment of pathology. Total removal of lesions in this area resulted in relief of symptoms in most patients, with minimum morbidity.
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Affiliation(s)
- D W Beck
- Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City
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Rigamonti D, Spetzler RF, Shetter A, Drayer BP. Magnetic resonance imaging and trigeminal schwannoma. SURGICAL NEUROLOGY 1987; 28:67-70. [PMID: 3589945 DOI: 10.1016/0090-3019(87)90209-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of trigeminal schwannoma, extending from the posterior fossa into Meckel's cave, is reported. The information provided by computed tomography, angiography, and magnetic resonance imaging allowed a correct preoperative diagnosis to be obtained. Due to the excellent sensitivity, the absence of bone artifacts, and the ease of imaging in any plane, magnetic resonance imaging best defined the "dumbbell" nature of the tumor, the atrophy of the masticatory muscles, and the infiltration of the third division of the trigeminal nerve.
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Abstract
Three cases of trigeminal neurinoma, which vary widely in their clinical features, location, and extension of the tumor are presented. Symptoms and radiological findings are described and supported by typical radiographs. Operation was carried out in all cases and the diagnosis of a neurinoma histologically confirmed.
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Affiliation(s)
- P Hammans
- Department of Neurosurgery, University of Bonn, West Germany
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Abstract
Over the past 10 years, 2000 patients with facial pain have been evaluated at the Mayfield Neurologic Institute. Sixteen of these patients were found to harbor intracranial tumors. The presenting features of this group of patients are analyzed, and the literature reviewed. Peripherally placed tumors tend to cause atypical facial pain associated with sensory loss. Middle fossa tumors may present as trigeminal neuralgia, but usually cause severe pain of an atypical nature and a progressive neurological deficit. Posterior fossa tumors are most likely to cause trigeminal neuralgia; these neoplasms are usually accompanied by subtle neurological deficits and are readily detected by current diagnostic studies.
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Abstract
Adenoid cystic carcinoma, or cylindroma, usually presents in the salivary glands or in the upper respiratory passages. We report an unusual case of adenoid cystic carcinoma in a 45-year-old woman who presented with a three-year history of progressive right trigeminal sensory palsy, most pronounced in the second division. There was, in addition, a right trigeminal motor palsy and a partial right 6th nerve palsy. CT scanning showed only a small soft tissue mass spanning an enlarged right foramen ovale. Solid adenoid cystic carcinoma was resected from Meckel's cave via a middle cranial fossa approach. A subsequent biopsy of the right maxillary antral mucosa found tumor tissue. We concluded that the tumor originated in the maxillary antrum and spread posteriorly along the infraorbital nerve to enlarge in the foramen ovale. Radiation to a total of 5,000 cGy was given. At 22 months there was neither radiographic nor clinical evidence of recurrence. At 30 months, the development of unsteady gait signalled the presence of recurrent tumor extending backwards from Meckel's cave into the right cerebello-pontine angle.
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Abstract
Trigeminal neurinomas account for about 0.2 per cent of all intracranial tumors and for about 2 to 3 per cent of all intracranial neurinomas. Trigeminal neurinomas occur most frequently in persons in the middle decades of life, with the highest incidence between the ages of 38 and 40 years. They show no sex predilection. Although very rare, trigeminal neurinomas are of considerable interest to the neurotologist because of their relation to the temporal bone, skull base, sphenoid and maxillary sinuses, nasopharynx, infratemporal fossa, and, in rare instances, the oral cavity. In addition to producing disturbances of fifth nerve sensory and motor function, these tumors are often associated with other symptoms, such as occlusion of the eustachian tube (sensation of fullness and conductive hearing loss), otalgia, exophthalmos, paralysis of the third, fourth, and sixth cranial nerves, and signs of posterior fossa involvement (sensorineural hearing loss, tinnitus, cerebellar ataxia, and involvement of cranial nerves VII and IX through XI), any of which may be the initial clinical manifestation of the neurinoma. Symptoms depend on the site of origin and course of development. Bilateral trigeminal neurinomas are a manifestation of the central form of neurofibromatosis.
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Abstract
The base of the skull lesions that arise anterior to the porus acusticus, clivus, or from the jugular carotid or hypoglossal canals present difficult surgical access. Plain films, arteriograms, and the conventional AP, lateral, and full base tomograms have often fallen short in allowing an easy understanding of the surgical relationships between these structures. The objectives of this thesis are 1. to present a previously unpublished tomographic view based on the surgical relationships, as encountered by the surgeon, that complement the traditional views and simplify the preoperative assessment of the lesion, 2. to review the literature on the subject, and 3. to present the author's experience with this view in use since 1976.
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Abstract
Meningiomas of Meckel's cave are unusual. Forty-six cases of this tumor are described in the literature and two others are reported in this paper. Symptomatology frequently begins with typical or atypical trigeminal neuralgia; when no other signs are associated, diagnosis of the tumor is difficult. Total removal of the tumor results in a complete relief of symptoms, and no other therapy for pain is necessary.
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Findler G, Feinsod M, Sahar A. Trigeminal neurinoma with unusual presentation. Report of a case with trigeminal somatosensory-evoked response. SURGICAL NEUROLOGY 1983; 19:351-3. [PMID: 6836494 DOI: 10.1016/0090-3019(83)90242-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A patient with trigeminal neurinoma, presenting unusual symptoms, is described. There was no trigeminal sensory or motor deficit. The only presenting symptoms were unilateral abducens nerve paresis and alternating hemiplegic episodes. The trigeminal somatosensory-evoked response was normal before surgery. After complete removal of the tumor from both the posterior and middle cranial fossae, severe trigeminal sensory deficit ensued, accompanied by impairment of the evoked response. Improvement of the trigeminal nerve function could be predicted by significant changes in a repeat trigeminal sensory-evoked response obtained 2 months after the operation.
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Vaquero J, Cabezudo JM, Leunda G, Carrillo R, Bravo G. Simultaneous posterior and middle cranial fossa neurinomas. Acta Neurochir (Wien) 1981; 55:321-7. [PMID: 6972155 DOI: 10.1007/bf01808448] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case of unilateral association of a neurinoma of the VIII nerve and a neurinoma of the temporal fossa in a 33-year-old woman without von Recklinghausen disease stigmata is presented. This uncommon association can mimic the picture of a trigeminal neurinoma with a dumb-bell extension into the posterior fossa.
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