硬膜外下垂門窩三叉神経鞘腫の切除に対する拡張内鼻アプローチ：2次元手術ビデオ

Expanded Endonasal Approach for Resection of Extradural Infratemporal Fossa Trigeminal Schwannoma: 2-Dimensional Operative Video.

• Karam Asmaro
• Jack Rock
• John Craig

抄録

顎下垂門窩（ITF）は、頭蓋底、具体的には卵巣孔が含まれている蝶形骨の大翼、によって上向きにバインドされています。このビデオでは、我々は、頭蓋骨基部の拡大した卵巣孔を持つ三叉神経の第三分節から発生したまれな、唯一の硬膜外、神経鞘腫の症例を報告しています。腫瘍はITFを満たし、下顎のシグモイドノッチを通って横方向に広がっていた。患者は左頬と下顎のしびれと断続的な左顎痙攣を訴えた。腫瘍は内視鏡的切除が適切と判断された。ITFにアクセスするために、まず、左側の内視鏡的副鼻腔手術、修正内視鏡的Denker's approach,4、および後鼻腔切除術が行われた。術中の脳脊髄液（CSF）漏れの修復が必要な場合に備えて、鼻中隔フラップも採取した。上顎洞後壁と翼口蓋骨窩からITFに達するまでの剥離が行われた。腫瘍の切除は、2人の外科医、適切な牽引と反対牽引を慎重に頭蓋骨の基部と非混和性の頸動脈管から離れて腫瘍をもみほぐすために適用された4手のアプローチを介して達成された。髄液漏れや頸動脈損傷はなく、上顎洞後壁欠損は鼻中隔フラップで修復された。術後の経過は良好であった。術後の経過は良好であり、患者は標準的な方法で手術に同意した。

The infratemporal fossa (ITF) is bounded superiorly by the skull base, specifically the greater wing of the sphenoid, which contains foramen ovale. It is bordered posteriorly by the temporal bone, including the petrous portion of the carotid canal, anteriorly by the posterior wall of the maxillary sinus, laterally by the mandible, and medially by the pterygoid body and lateral pterygoid plate.1-3 In this video, we report a case of a rare, exclusively extradural, schwannoma originating from the third division of the trigeminal nerve with a widened foramen ovale at the skull base. The tumor filled the ITF and extended laterally just through the sigmoid notch of the mandible. The patient complained of left cheek and lower jaw numbness and intermittent left jaw spasms. The tumor was deemed appropriate for endoscopic resection. To access the ITF, left-sided endoscopic sinus surgery, a modified endoscopic Denker's approach,4 and posterior nasal septectomy were first performed. A nasoseptal flap was also harvested in case an intraoperative cerebrospinal fluid (CSF) leak required repair. Dissection was carried out through the posterior wall of the maxillary sinus and pterygopalatine fossa to reach the ITF. Tumor resection was achieved through a 2-surgeon, 4-handed approach in which appropriate traction and countertraction were carefully applied to tease the tumor away from the skull base and dehiscent carotid canal. No CSF leak or carotid injury occurred, and the posterior maxillary sinus wall defect was repaired with the nasoseptal flap. The patient did well postoperatively.  The patient consented to the procedure in a standard fashion.

Copyright © 2020 by the Congress of Neurological Surgeons.