Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach

doi:10.3969/j.issn.1672-6731.2020.12.011

Abstract

Abstract:

Objective To investigate the efficacy and safety of cranio-orbital approach for the removal of cavernous sinus-orbital communication trigeminal schwannomas. Methods and Results A total of 23 patients with cavernous sinus-orbital communication trigeminal schwannoma were included from January 2013 to January 2019, the combined cranio-orbital approach (modified Dolenc approach combined with supraorbital approach) was used for surgical resection of tumors. Total tumor resection was performed in 20 cases and nearly total resection in 3 cases. Thirteen patients with preoperative visual loss, 7 of them further decreased visual acuity; 5 cases with preoperative eye movement disorder and/or ptosis, 3 cases with residual eye movement disorder, and 11 cases appeared new eye movement disorders after surgery. None of the 23 cases occurred cerebrospinal fluid leakage, intracranial hematoma or intracranial infection occurred, no death and no tumor recurrence case. Conclusions Cavernous sinus-orbital communication trigeminal schwannoma, due to the special tumor occurrence site and surrounding anatomical structure, was easy to cause complications such as visual loss and eye movement disorder during operation. The combined cranio-orbital approach was used, it may increase the total resection rate, and also show relatively low surgical complications rate.

Key words: Trigeminal nerve, Neurilemmoma, Cavernous sinus, Orbit, Microsurgery, Postoperative complications

摘要：

目的探讨经颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤的疗效和安全性。方法与结果 纳入2013年1月至2019年1月经颅眶联合入路即改良Dolenc入路联合眶上入路手术切除海绵窦-眼眶沟通三叉神经鞘瘤患者共23例，其中肿瘤全切除20例、近全切除3例。13例术前即存在视力下降患者中7例视力进一步下降；5例术前眼动障碍和（或）上睑下垂患者中3例残留眼动障碍，另有11例术后新发眼动障碍。23例中无一例发生脑脊液漏、颅内血肿或颅内感染，无死亡或肿瘤复发病例。结论由于海绵窦-眼眶沟通三叉神经鞘瘤部位与周围毗邻解剖结构关系特殊，术后易出现视力下降和眼动障碍等并发症，采用经颅眶联合入路手术，全切除率较高、手术相关并发症发生率相对较低。

关键词: 三叉神经, 神经鞘瘤, 海绵窦, 眼眶, 显微外科手术, 手术后并发症

SUN Si, KANG Jun, ZHAO Shang-feng, QIU E, LI Yong, SHI Ji-tong, MA Jian-min. Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1092-1098.

孙思, 康军, 赵尚峰, 邱锷, 李永, 史继桐, 马建民. 颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤[J]. 中国现代神经疾病杂志, 2020, 20(12): 1092-1098.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.12.011

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References

[1] Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas[J]. J Neurosurg, 1995, 82:711-718.
[2] Alafaci C, Caffo M, Barresi V, Cutugno M, Pino MA, Granata F, De Ponte FS, Salpietro FM, Tomasello F. Large trigeminal schwannoma of the infratemporal fossa:evaluation of neoangiogenesis in this rare neoplasm[J]. Head Neck, 2013, 35:E272-276.
[3] Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae:surgical methods and review of the literature[J]. J Neurosurg, 1999, 91:202-211.
[4] Kron M, Bohnsack BL, Archer SM, McHugh JB, Kahana A. Recurrent orbital schwannomas:clinical course and histopathologic correlation[J]. BMC Ophthalmol, 2012, 12:44.
[5] Wang Y, Xiao LH. Orbital schwannomas:findings from magnetic resonance imaging in 62 cases[J]. Eye (Lond), 2008, 22:1034-1039.
[6] Dallan I, Castelnuovo P, Turri-Zanoni M, Fiacchini G, Locatelli D, Battaglia P, Sellari-Franceschini S. Transorbital endoscopic assisted management of intraorbital lesions:lessons learned from our first 9 cases[J]. Rhinology, 2016, 54:247-253.
[7] Dallan I, Di Somma A, Prats-Galino A, Solari D, Alobid I, Turri-Zanoni M, Fiacchini G, Castelnuovo P, Catapano G, de Notaris M. Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band:a descriptive anatomical study[J]. J Neurosurg, 2017, 127:622-629.
[8] Jeon C, Hong CK, Woo KI, Hong SD, Nam DH, Lee JI, Choi JW, Seol HJ, Kong DS. Endoscopic transorbital surgery for Meckel's cave and middle cranial fossa tumors:surgical technique and early results[J]. J Neurosurg, 2018, 1:1-10.
[9] Dolenc VV. Frontotemporal epidural approach to trigeminal neurinomas[J]. Acta Neurochir (Wien), 1994, 130(1-4):55-65.
[10] Yu XG, Zhou DB, Xu BN, Zhang YZ. Surgical treatment of intracavernous lesion using Dolenc approach[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2002, 18:379-383.[余新光, 周定标,许百男, 张远征. 采用Dolenc入路处理海绵窦病变[J]. 中华神经外科杂志, 2002, 18:379-383.]
[11] Yasuda A, Campero A, Martins C, Rhoton AL Jr, Ribas GC. The medial wall of the cavernous sinus:microsurgical anatomy[J]. Neurosurgery, 2004, 55:179-189.
[12] Yasuda A, Campero A, Martins C, Rhoton AL Jr, de Oliveira E, Ribas GC. Microsurgical anatomy and approaches to the cavernous sinus[J]. Neurosurgery, 2008, 62(6 Suppl 3):1240-1263.
[13] Mishra S, Leão B, Rosito DM. Extradural anterior clinoidectomy:technical nuances from a learner's perspective[J]. Asian J Neurosurg, 2017, 12:189-193.
[14] Goel A, Shah A, Muzumdar D, Nadkarni T, Chagla A. Trigeminal neurinomas with extracranial extension:analysis of 28 surgically treated cases[J]. J Neurosurg, 2010, 113:1079-1084.
[15] Zhao Y, Li HQ, Zhao H, Pan Y. Diagnostic and therapeutical analysis of orbital neurilemomas[J]. Zhonghua Yan Ke Za Zhi, 2018, 54:509-514.[赵云, 李浩晴, 赵红, 潘叶. 眼眶神经鞘瘤112例的诊断和治疗分析[J]. 中华眼科杂志, 2018, 54:509-514.]
[16] Feng SY, Bu B, Yu XG, Chen XL, Zhang YY, Zhao R, Ren HC, Meng XH, Zhou T. Trans-extradural approach to resect trigeminal schwannomas involving the cavernous sinus region[J]. Zhonghua Wai Ke Za Zhi, 2013, 51:1099-1103.[冯世宇,卜博, 余新光, 陈晓雷, 张艳阳, 赵然, 任贺成, 孟祥辉, 周涛.硬膜外入路处理中颅窝-海绵窦区三叉神经鞘瘤[J]. 中华外科杂志, 2013, 51:1099-1103.]
[17] Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal schwannomas:skull base approaches and operative results in 105 patients[J]. Neurosurgery, 2012, 70(1 Suppl Operative):132-143.
[18] Tripathi M, Batish A, Kumar N, Ahuja CK, Oinam AS, Kaur R, Narayanan R, Gurnaani J, Kaur A. Safety and efficacy of single-fraction gamma knife radiosurgery for benign confined cavernous sinus tumors:our experience and literature review[J]. Neurosurg Rev, 2020, 43:27-40.

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