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[Surgical management of dumbbell-shaped trigeminal neurinomas]
1Department of Neurosurgery, Huashan Hospital, Shanghai Fudan University, Shanghai 200032, China.
Objective:
To investigate the best surgical approach for the removal of dumbbell-shaped trigeminal neurinomas (DSTNs).
Methods:
The clinical materials of 46 patients with DSTNs surgically treated were analysed retrospectively. The patients were divided into two groups. In the early group (1978 - 1984), a series of conventional intradural approaches were used, and in the late group (1985 - 2000), an epidural approach via the skull-base craniotomy was used.
Results:
Total tumor removal was achieved in 42% (5/12) of the early group and 85% (29/34) of the late group (chi(2) = 8.8, P < 0.01). Temporary and permanent cranial nerve morbidities were 63% and 47% (chi(2) = 3.4, P > 0.05) in the early group and 48% and 15% in the late group (chi(2) = 6.1, P < 0.05).
Conclusion:
The best microsurgical approach for the removal of DSTNs is epiduro-transduro-transtentorial approach via skull-base craniotomy. It is not necessary to resect the petrous apex.