Epidural and subdural interdural approach to the lateral wall of the cavernous sinus for preserving the laterocavernous sinus in trigeminal schwannoma

Use of a Suction-Monopolar Stimulator for Continuous Neurophysiology Monitoring During Endonasal Resection of a Cavernous Sinus Schwannoma: 2-Dimensional Operative Video

Cavernous sinus schwannomas are exceptionally rare tumors.1,2 Although these tumors commonly originate from the trigeminal nerve, instances involving the oculomotor, abducens, trochlear nerves, and the carotid plexus have also been documented.2-7 In this operative video, we showcase a 44-year-old man with a medical history of acromegaly and schwannomatosis who presented with retro orbital pain and a growing cystic lesion in the left cavernous sinus. Genetic testing ruled out neurofibromatosis types 1 and 2. An endonasal resection was recommended considering the left side and extradural location of the lesion.8 The tumor was excised through an endonasal transpterygoid approach using 2 suctions, one of which was equipped with an electrode tip for continuous monitoring of extraocular nerves during the resection process. Imaging postoperatively demonstrated near-total resection. Institutional review board approval was not required; the patient agreed to undergo the procedure and to have his operative video published.

Operative management of trigeminal schwannomas: based on a modified classification in a study of 93 cases

BACKGROUND

Advances in microscopic and endoscopic surgical techniques have outpaced traditional classification and transcranial surgical strategies, especially with reference to the treatment of trigeminal schwannomas (TSs). A modified TS classification is proposed and appropriate surgical strategies are discussed.

METHODS

The cases of 93 patients who underwent surgical treatment in Beijing Tiantan Hospital in the previous 6 years were analyzed retrospectively, and a literature review was conducted.

RESULTS

Classification is based on surgical direction. Tumors were classified as follows: type A, backward orientation, located in the orbit or orbit and middle cranial fossa (8 cases, 8.6%); type B, upward orientation, located in the pterygopalatine fossa, infratemporal fossa or pterygopalatine fossa, infratemporal fossa, and middle cranial fossa (23 cases, 24.7%); type C, forward and backward orientations, located in the middle cranial fossa, posterior cranial fossa or both (58 cases, 62.4%); and type D, located in multiple regions (4 cases, 4.3%). 91.40% of patients underwent gross total resection (GTR) with 29 cases receiving endoscopic resection of whom 93.10% (27/29) experienced GTR.

CONCLUSION

The 93 cases were satisfactorily divided into four types, according to tumor location and surgical orientation, enabling safe and effective removal by appropriate surgery.

Microscopic with Endoscopic Surgery via Subtemporal Approach for Cavernous Sinus Cholesteatomas

OBJECTIVE

The aim of this study was to retrospectively analyze the clinical data of 16 patients with cavernous sinus cholesteatomas, explore the surgical outcomes, and summarize the surgical experience.

METHODS

Patients with cavernous sinus cholesteatomas underwent surgery between June 2016 and June 2022 at the Department of Neurosurgery at the First Affiliated Hospital of Soochow University. Clinical data were obtained from all patients for analysis.

RESULTS

Common preoperative symptoms included headache, dizziness, diplopia, ptosis, and facial numbness. There were 7 patients with 2 or more symptoms. There were 13 patients with total resection and 3 patients with subtotal resection. There were 5 patients with improved postoperative symptoms, 10 patients with no significant change, and 1 patient with worse symptoms. New postoperative cranial nerve defects occurred in 4 patients. During the follow-up, all patients had favorable prognosis without progression.

CONCLUSIONS

Using "double-scope" technique, the subtemporal approach, a surgical strategy for cavernous sinus cholesteatomas, was sufficient to completely resect the tumors.