Subtemporal interdural approach to dumbell-shaped trigeminal schwannoma: cadeveric prosection

초록

목적:Successful resection of dumbell-shaped trigemintal shcwannnoma through subtemporal interdural approach requireds understanding both of anatomy related to the bone resection of the petroud apex( Kqwase's triangle/ queadrilateral) and meningeal anatomy. We performed this study to detail the meningeal anatomy ralated to this appoach and to present the dural inciseions and mobilization in stpe-wise fashion. 대상: Meningeal anatomy around Meckel's cave(MC) and porus trigeminus was examined during the subtemporal interdural anterior transpetrosal apporach in 30 sides of 15 cadeveris heads. Histological study of MC region was performed in 2 cadeveris heads. 결과: The gasserian ganglion and the trigemiral roots have two layers of dural propria on their dorsolaterl surface: inner layer from the posterionr fossa dural propria constituinf the dorsolaterl wall of MC; outer layer from the dura propria of the middle fossa. The cleavage plane between these two layers continues distally as the cleavage plane between the epineural sheaths of the trigemial divisions and the dura propria of the middle fossa. This cleavage plane serves as the anatomincal basis for the interdural exposure of the contents of MC. The superior petrosal sinus is sectioned at the meidal aspect of Kawase's triganel and reflected along with the roof of the porus trigeminus. 결론: Understanding of the critical menigeal architecture of and around the MC allows the experienced cranial neurosurgeon to develop a subtemporal interdural approach to dumbell-shapedd trigernial schwannomas which effectivelt converts a multiple compartment tumor into a single compartemnt tumor. The method of dural incisions and mobilization is presented in a step-wise fashion and completment previoious description of the bony stes necessary to accomplish this surgical approach.