title: Frontotemporal epi- and subdural approach to a cavernous sinus tumor for sphenobasal vein preservation--technical case report.
abstract: In cavernous sinus (CS) surgery, venous complication may occur in some types of venous drainage. The sphenobasal vein (SBV) drains from the superficial middle cerebral vein (SMCV) to the pterygoid venous plexus at the temporal skull base. A frontotemporal epi- and interdural approach (Dolenc approach), which is one of the CS approaches, may damage the SBV's route. We report a case of intracavernous trigeminal schwannoma that contained the SBV and discuss our modified surgical procedure that combined epi- and subdural approaches to preserve the SBV. A 64-year-old man complained of right progressive oculomotor palsy and was referred to our hospital for surgery. MR images revealed a hemorrhagic tumor in the right CS. Three-dimensional venography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. After identifying the first branch of the trigeminal nerve epidurally, we incised the dura linearly along the sylvian fissure and entered the subdural space to visualize the SBV. The incision was continued to the meningeal dura of the lateral wall of the CS along the superior margin of the first branch of the trigeminal nerve, and the Parkinson's triangle was opened from the subdural side. The tumor was grossly totally removed, and the SBV was preserved. In conclusion, a frontotemporal epi- and subdural approach to the intracavernous trigeminal schwannoma can effectively preserve the SBV.
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. pochisuke616@mac.com.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Shibao
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Takenori
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kuramae
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Mochizuki
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D001763:Blepharoptosis / Q000209:etiology / Q000628:therapy; D002426:Cavernous Sinus / Q000601:surgery*; D002550:Cerebral Veins / Q000601:surgery*; D004824:Epidural Space / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D009886:Ophthalmoplegia / Q000209:etiology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000150:complications / Q000601:surgery*; D013355:Subdural Space / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cavernous sinus tumor; Intracavernous trigeminal schwannoma; Sphenobasal vein; Venous preservation