Infratemporal fossa interdural approach for trigeminal neurinomas

Area of Science:

• Neurosurgery
• Surgical Oncology

Background:

• Trigeminal neurinomas are benign tumors that can cause significant neurological deficits.
• Resection of large trigeminal neurinomas presents surgical challenges due to their location and proximity to critical structures.

Purpose of the Study:

• To evaluate the efficacy and safety of a specific surgical approach for large trigeminal neurinomas.
• To describe a minimally invasive technique for accessing tumors involving the infratemporal fossa, Meckel's cave, and cavernous sinus.

Main Methods:

• A small craniectomy in the infratemporal fossa, including the foramen ovale, was performed.
• Surgical technique involved opening the dural sheath around the mandibular nerve and Gasserian ganglion.
• Head positioning and surgical angles were adjusted to achieve a basal view, facilitating tumor exposure and control of the carotid artery.

Main Results:

• Four large trigeminal neurinomas were successfully resected using this approach.
• The technique allowed for control of the carotid artery at the petrous apex.
• Complete tumor resection was achieved without significant brain retraction.

Conclusions:

• This infratemporal fossa craniectomy approach provides a strategic route for resecting large trigeminal neurinomas.
• The technique offers safe and complete tumor removal while avoiding brain retraction.
• This method is considered ideal for selected cases of trigeminal neurinomas involving complex anatomical regions.