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Chavez-Herrera VR, Campero Á, Ballesteros-Herrera D, Sandoval-Bonilla BA, Perez-Carrillo CA, Soto-Rubio DT, Valladares-Pérez EJ, González-Zavala PA, Castillejo-Adalid LA, Rodríguez-Hernández JJ. Microsurgical and illustrative anatomy of the cavernous sinus, middle fossa, and paraclival triangles: a straightforward, comprehensive review. Surg Radiol Anat 2023; 45:389-400. [PMID: 36853414 PMCID: PMC10039822 DOI: 10.1007/s00276-023-03105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.
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Affiliation(s)
- Víctor Ramzes Chavez-Herrera
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Álvaro Campero
- Department of Neurosurgery, Padilla Hospital, Tucumán, Argentina
| | - Daniel Ballesteros-Herrera
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugia, Manuel Velasco Suarez, Ciudad de México, Mexico
| | - Bayron Alexander Sandoval-Bonilla
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Cristian Alberto Perez-Carrillo
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Diego Tonathiu Soto-Rubio
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Eduardo Javier Valladares-Pérez
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Pedro Adrián González-Zavala
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Luis Alfonso Castillejo-Adalid
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - Job Jesús Rodríguez-Hernández
- Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
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Karthigeyan M, Mishra K, Salunke P, Ahuja CK, Vignesh G. An Unusual Petrous-Based Lesion with Rim Calcification. Neurol India 2022; 70:2286-2287. [PMID: 36352680 DOI: 10.4103/0028-3886.359165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Keshav Mishra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chirag Kamal Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gopalarathinam Vignesh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII). Acta Neurochir (Wien) 2022; 164:299-319. [PMID: 35079891 DOI: 10.1007/s00701-021-05092-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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Uppar AM, Rao S, Prasad C, Arimappamagan A, Santosh V. Schwannoma of the Greater Superficial Petrosal Nerve: An Unusual Site for a Common Tumor. J Neurol Surg A Cent Eur Neurosurg 2020; 81:565-570. [PMID: 32361981 DOI: 10.1055/s-0039-1685168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Greater superficial petrosal nerve (GSPN) schwannoma is a rare clinical entity. It forms a small subset of the larger group of facial nerve schwannomas. A thorough literature search yielded only 27 such cases reported to date in the English literature. We present one such rare case of GSPN schwannoma and discuss the clinical spectrum and management along with a review of the literature. We demonstrate the surgical steps in an operative video.
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Affiliation(s)
- Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Chandrajit Prasad
- NIIR, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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Ishikawa T, Matsuda M, Sakakura K, Ishikawa E, Akutsu H, Matsumura A. Huge Greater Superficial Petrosal Nerve Schwannoma with Intradural Peritumoral Cyst. World Neurosurg 2019; 122:85-89. [DOI: 10.1016/j.wneu.2018.10.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022]
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Chen F, Zhao S, Yu Y, Chen D. Intraparenchymal schwannoma with calcification of the temporal lobe: Case report and literature review. Medicine (Baltimore) 2019; 98:e14263. [PMID: 30681624 PMCID: PMC6358367 DOI: 10.1097/md.0000000000014263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Intracranial schwannomas most frequently arise from the trigeminal nerve and the vestibular nerve. Schwannomas within the cerebral parenchyma are exceedingly rare. Additionally, calcification is an uncommon histopathological and radiological characteristic in schwannomas. PATIENT CONCERNS A 46-year-old man presented to us with sudden onset epileptic seizure and a 3-month history of intermittent headache. After admission, the physical and neurological examinations were all normal. Brain CT revealed an irregular, well-defined, hyperdense mass in the right temporal lobe. MRI showed a solid mass appearing iso- to hypointensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging in the right temporal lobe; after Gd-DTPA administration, the lesion showed heterogeneous enhancement. DIAGNOSIS Histopathological examination revealed hyperchromatic nuclei and loose intercellular matrix with calcification. Immunohistochemical analysis demonstrated that the tumor was strongly positive for S100 protein but negative for GFAP and CK, which was consistent with a schwannoma. INTERVENTIONS AND OUTCOMES A surgical resection via the right temporal approach was performed. Intraoperatively, we noticed that the tumor was grayish yellow, capsuled, and located entirely within the temporal parenchyma. A gross total resection was achieved. The postoperative course was uneventful, and there was no epileptic seizure. LESSONS Intraparenchymal schwannoma with calcification is an uncommon histopathological and radiological characteristic in schwannomas. Intraparenchymal schwannoma with calcification is extremely rare. The early identification and appropriate surgical treatment should be highlighted.
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Affiliation(s)
| | - Shuai Zhao
- Anesthesiology, First Hospital of Jilin University, Changchun, China
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Takase H, Araki K, Seki S, Takase K, Murata H, Kawahara N. Unique Diagnostic Features and Surgical Strategy for Intracranial Carotid Sympathetic Plexus Schwannoma: Case Report and Literature Review. World Neurosurg 2017; 98:876.e1-876.e8. [DOI: 10.1016/j.wneu.2016.11.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
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