scholarly journals Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Riccardo Caruso ◽  
Alessandro Pesce ◽  
Venceslao Wierzbicki ◽  
Luigi Marrocco ◽  
Emanuele Piccione
Keyword(s):  
Cavernous Sinus ◽  
Surgical Approach ◽  
Rare Case ◽  
Postoperative Morbidity ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Technical Note ◽  
Trigeminal Schwannoma ◽  
Rare Lesion

We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.

Isolated Trigeminal Nerve Sarcoid Granuloma Mimicking Trigeminal Schwannoma: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 700-705 ◽  
Author(s):  
Alfredo Quinones-Hinojosa ◽  
Edward F. Chang ◽  
Saad A. Khan ◽  
Michael W. McDermott
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Frozen Section ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Neurophysiological Monitoring ◽  
Pathology Report ◽  
Trigeminal Schwannoma ◽  
Sarcoid Granuloma

Abstract OBJECTIVE AND IMPORTANCE Sarcoidosis most commonly presents as a systemic disorder. Infrequently, sarcoidosis can manifest itself in the central nervous system, with granulomas involving the leptomeninges and presenting with facial nerve weakness. Sarcoid of the trigeminal nerve is exceedingly rare and can mimic trigeminal schwannoma. We review the literature on sarcoid granulomas of the trigeminal nerve and compare their radiological features with the more common schwannoma. CLINICAL PRESENTATION A 33-year-old woman presented with a history of left-sided facial pain and numbness for 11 months, which was presumed to be trigeminal neuralgia. A trial of carbamazepine had been unsuccessful in relieving the facial pain. Her neurological examination revealed decreased facial sensation in the V1–V2 distribution. Preoperative magnetic resonance imaging demonstrated a contrast-enhancing mass centered in the left cavernous sinus with extension along the cisternal portion of the left trigeminal nerve. INTERVENTION The patient underwent a left frontotemporal orbitozygomatic craniotomy with intraoperative neurophysiological monitoring of Cranial Nerves III, V, and VI and image guidance for subtotal microsurgical resection of what appeared, grossly and on frozen section, to be a neurofibroma. The final pathology report, however, revealed a sarcoid granuloma of the trigeminal nerve. CONCLUSION The differential diagnosis of contrast-enhancing lesions in the lateral wall of the cavernous sinus should include inflammatory conditions such as sarcoidosis. We recommend that surgery for biopsy or decompression be used only for those patients in whom a diagnosis cannot be confirmed with noninvasive testing. If surgery is performed, intraoperative frozen pathology is very useful in guiding the extent of resection.

scholarly journals The extradural temporopolar approach: a review of indications and operative technique

2008 ◽  
Vol 25 (6) ◽  
pp. E3 ◽  
Author(s):  
Gabriel Zada ◽  
J. Diaz Day ◽  
Steven L. Giannotta
Keyword(s):  
Cavernous Sinus ◽  
Basilar Artery ◽  
Operative Technique ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Lateral Wall ◽  
Superior Cerebellar Artery ◽  
Trigeminal Schwannoma ◽  
Cerebellar Artery ◽  
Brain Retraction

Object The extradural temporopolar approach is used for enhanced exposure of the cavernous sinus and petroclival regions in the treatment of complex lesions not amenable to sole treatment via radiosurgical or endovascular methods. The authors' objective was to review the indications, surgical experience, and operative technique in a series of patients who underwent surgery with this approach. Methods The authors conducted a retrospective review to identify patients who underwent a temporopolar approach from 1992 to 2008. An orbitozygomatic craniotomy was frequently used, followed by extradural retraction of the temporal lobe. A sequential progression of bone removal at the anterior and middle skull base, followed by opening the layers of the lateral wall of the cavernous sinus was next performed to safely retract the brain and widen the exposure to the cavernous sinus, interpeduncular fossa, and upper petroclival regions. Results Sixty-six patients were identified and included in the study. The mean patient age was 49 years. The main indications for surgery were as follows: meningioma (25 patients, 38%), basilar artery aneurysm (11 patients, 17%), trigeminal schwannoma (7 patients, 11%), chordoma (5 patients, 7%), hemangioma (3 patients, 5%), pituitary adenoma (3 patients, 5%), superior cerebellar artery aneurysm (3 patients, 5%), and other lesions (9 patients, 14%). Complications included hemiparesis in 4 patients (6%), infarcts in 4 patients (6%), transient aphasia in 1 patient (1.5%), and cranial nerve paresis in 20 patients (30%). Conclusions The extradural temporopolar approach offers a relatively safe and wide exposure of the sphenocavernous and petroclival regions. Mobilization of the cranial nerves and internal carotid artery allow gentle brain retraction and maximal preservation of venous outflow. This is an advantageous approach to large tumors in these regions and for complex upper basilar artery or superior cerebellar artery aneurysms.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

Development of Artificial Cranial Base Model With Soft Tissues for Practical Education

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE339-onsE341 ◽  
Author(s):  
Kentaro Mori ◽  
Takuji Yamamoto ◽  
Yasuaki Nakao ◽  
Takanori Esaki
Keyword(s):  
Cavernous Sinus ◽  
Dura Mater ◽  
Soft Tissues ◽  
Surgical Simulation ◽  
Cranial Nerves ◽  
Single Layer ◽  
Lateral Wall ◽  
Cranial Base ◽  
Superior Orbital Fissure ◽  
3 Dimensional

Abstract OBJECTIVE Improved educational tools for anatomic understanding and surgical simulation of the cranial base are needed because of the limited opportunities for cadaver dissection. A 3-dimensional cranial base model with retractable artificial dura mater is essential to simulate the epidural cranial base approach. METHODS We developed our 3-dimensional cranial base model with artificial dura mater, venous sinuses, cavernous sinus, internal carotid artery, and cranial nerves, and the extradural temporopolar approach was simulated using this new model. INSTRUMENTATION This model can be dissected with a surgical drill because of the artificial bone material. The periosteal dura was reconstructed in the medial wall of the cavernous sinus, periorbita, and periosteal bridge in the superior orbital fissure with yellow silicone. The meningeal dura was made with brown silicone. The single-layer dura mater could be dissected from the bone surface and retracted with a surgical spatula. RESULTS Extradural drilling of the superior orbital fissure and opening of the optic canal were similar to actual surgery. Extradural anterior clinoidectomy was performed via the extradural space by retracting the artificial dura mater. The artificial dura propria of the lateral wall in the cavernous sinus was successfully peeled from the artificial cranial nerves to complete the extradural temporopolar approach. CONCLUSION The improved 3-dimensional cranial base model provides a useful educational tool for the anatomic understanding and surgical simulation of extradural cranial base surgery.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

scholarly journals Extended Middle Fossa Approach for Trigeminal Schwannoma Resection

2021 ◽  
Author(s):  
Baha'eddin A. Muhsen ◽  
Edinson Najera ◽  
Hamid Borghei-Razavi ◽  
Badih Adada
Keyword(s):  
Cavernous Sinus ◽  
Brain Mri ◽  
Clinical Status ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Benign Tumors ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare benign tumors, it is second most common intracranial schwannomas after vestibular schwannomas. The management includes not limited to observation, stereotactic radiosurgery/radiotherapy, and/or surgical resection. Tumor size and patient clinical status are the most important factors in management.In this video, we describe the technical nuances of an extended middle fossa approach for large trigeminal schwannoma with cavernous sinus extension resection. A 44-year-old right-handed female with several months' history of progressive right facial paresthesia and pain in the distribution of V3 mainly. On physical examination, she had decreased sensation to light touch over the right V1 to V3 distribution with loss of cornel reflex. The brain MRI showed 3.5 cm bilobed mass extends from the pontine root entry zone to the cavernous sinus. Craniotomy was performed and followed by middle fossa dural peeling, peeling of temporal lobe dura away from the wall of the cavernous sinus, extradurally anterior clinoidectomy, drilling of the petrous apex, coagulation of superior petrosal sinus followed incision of the tentorium up to the tentorial notch with preservation the fourth cranial nerve, and tumor dissected away from V1 and then gradually removed from the superior wall of the cavernous sinus.The technique presented here allows for complete tumor resection, safe navigation through the relative cavernous sinus compartments, and minimizes the possibility of inadvertent injury to the cranial nerves.The postoperative course was uneventful except for right eye incomplete ptosis from the swelling. Her facial pain subsided after the surgery without any extra ocular movement impairment.The link to the video can be found at: https://youtu.be/zxi2XK2R9QU.

scholarly journals Surgical treatment for a rare case of ectopic tooth in the lateral wall of the nasal cavity

2020 ◽  
Vol 8 (11) ◽  
Author(s):  
Manoela Moura De Bortoli ◽  
José Alcides Almeida de Arruda ◽  
Ricardo José Holanda Vasconcellos ◽  
Emanuel Dias Oliveira e Silva ◽  
Ana Karina de Medeiros Tormes ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Nasal Cavity ◽  
Surgical Approach ◽  
Rare Case ◽  
Treatment Plan ◽  
Lateral Wall ◽  
Postoperative Result ◽  
Endoscopic Extraction ◽  
Ectopic Tooth

Among the ways to approach cases of ectopic teeth, the surgical approach is a valid option and should be considered, since it is considered simple and it permits direct visualization and a rapid recovery. The aim of this article is to report a rare case of ectopic tooth in the lateral wall of the nasal cavity caused by trauma in the maxillofacial region in childhood, and to describe its clinical and imaging characteristics as well as ways of treatment and surgical aspects. A 25-year-old woman was seen at the clinic of Maxillofacial Surgery and Traumatology due to the presence of a foreign body in the nose. A treatment plan was elaborated based on physical and radiographic examination. The tooth was removed by a surgical approach and the patient underwent esthetic rehabilitation. Surgical treatment of ectopic teeth provides a good and satisfactory postoperative result, is simple and mostly without complications. Ectopic teeth are rare, and the professional should be able to perform the diagnosis, indication and planning of treatment, as well as its execution. Surgical treatment is an option that produced an effective result in the present case.Descriptors: Mouth; Tooth, Impacted; Ambulatory Surgical Procedures.ReferencesVerma RK, Bakshi J, Panda NK. Ectopic intranasal tooth: an unusual cause of epistaxis in a child. Ear Nose Throat J. 2012;91(6):242-44.Gupta YK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a four years old child: case report and literature review. Int J Paediatr Dent. 2001;11(3):221-24.Thor AL. Delayed removal of a fully intruded primary incisor through the nasal cavity: a case report. Dental Traumatol. 2002;18(4):227-30.Koçak HE, Özdamar K, Bilgi B, Aipayam H. Case report a rare cause of intranasal mass: bilateral ectopic nasal teeth. Iran J Otorhinolaryngol. 2017;29(94):287-89.Van Essen TA, Van Rijswijk JB. Intranasal toothache case report. J Laryngol Otol. 2013;127(3):321-22.Kim DH, Kim JM, Chae SW, Hwang SJ, Lee SH, Lee HM. Endoscopic removal of an intranasal ectopic tooth. Int J Pediatr Otorhinolaryngol. 2003;67(1):79-81.Ray B, Singh LK, Das CJ, Roy TS. Ectopic supernumerary tooth on the inferior nasal concha. Clin Anat. 2006;19(1):68-74.Zalagh M, Akhaddar A, Benariba F. Chronic rhinorrhea revealing an actinomycotic rhinolithiasis with ectopic tooth. Int J Oral Maxillofac Surg. 2012;41(3):297-99.Moreano EH, Zich DK, Goree JC, Graham, SM. Nasal tooth. Am J Otolaryngol. 1998;19(2):124-26.Sammatino G, Trosino O, Perillo L, Cioff A, Marenzi G, Mortellaro C. Alternative transoral approach for intranasal tooth extraction. J Craniofac Surg. 2011;22(5):1944-46.Lee FP. Endoscopic extraction of an intranasal tooth: a review of 13 cases. Laryngoscope. 2001;111(6):1027-31.

Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: case series and technical note

2012 ◽  
Vol 32 (5) ◽  
pp. E14 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Pascal Jabbour ◽  
Aaron S. Dumont ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Case Series ◽  
Technical Note ◽  
Arterial System ◽  
Embolic Material ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach

Object Multiple approaches have been used to treat carotid-cavernous fistulas (CCFs). The transvenous approach has become a popular and effective route. Onyx is a valuable tool in today's endovascular armamentarium. The authors describe the use of a balloon-assisted technique in the treatment of CCFs with Onyx and assess its feasibility, utility, and safety. Methods The authors searched their prospectively maintained database for CCFs embolized using Onyx with the assistance of a compliant balloon placed in the internal carotid artery (ICA). Results Five patients were treated between July 2009 and July 2011 at the authors' institution. A balloon helped to identify the fistulous point, served as a buttress for coils, protected from inadvertent arterial embolizations, and prevented Onyx and coils from obscuring the ICA during the course of embolization. No balloon-related complications were noted in any of the 5 cases. All 5 fistulas were completely obliterated at the end of the procedure. Four patients had available clinical follow-ups, and all 4 showed reversal of nerve palsies. Conclusions Balloon-assisted Onyx embolization of CCFs offers a powerful combination that prevents inadvertent migration of the embolic material into the arterial system, facilitates visualization of the ICA, and serves as a buttress for coils deployed in the cavernous sinus through the fistulous point. Despite adding another layer of technical complexity, an intraarterial balloon can provide valuable assistance in the treatment of CCFs.

Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study

2018 ◽  
Vol 127 (12) ◽  
pp. 903-911 ◽  
Author(s):  
Sameh M. Amin ◽  
Hesham Fathy ◽  
Ahmed Hussein ◽  
Mohamed Kamel ◽  
Ahmed Hegazy ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Maxillary Nerve ◽  
Bony Landmarks ◽  
Extradural Approach

Objective: A transcranial extradural approach to the middle cranial fossa (MCF) requires separation of the dural layers of the lateral wall of the cavernous sinus. The authors tested the feasibility of an endonasal approach for this separation. Methods: A cadaveric feasibility study was conducted on the sides of 14 dry skulls and 10 fresh cadaveric heads. An endonasal, transsphenoidal, transpterygoid approach was taken to the MCF. The maxillary struts and medial greater wing of the sphenoid below the superior orbital fissure were drilled with transposition of the maxillary nerve. The lateral cavernous dural layers were split at the maxillary nerve with separation of the temporal lobe dura and exposure of the MCF bony base. The integrity of the cranial nerves and inner and outer dural layers of the lateral cavernous wall was checked. Different measurements of bony landmarks were obtained. Results: The integrity of the dural layers of the lateral cavernous wall and the cranial nerves were preserved in 10 heads. The mean area of the bony corridor was 4.68 ± 0.97 cm2, the V2-to-V3 distance was 15.21 ± 3.36 mm medially and 18.21 ± 3.45 mm laterally, and the vidian canal length was 13.01 ± 3.06 mm. Conclusions: Endonasal endoscopic separation of the lateral cavernous dural layers is feasible without crossing the motor cranial nerves, allowing better exposure of the MCF.

Sign in / Sign up

Export Citation Format

Share Document