A Combined Supra-and Infrntentorial Traspetrosal Approach for Surgical Treatment of Tumors Extending from the Cerebellopontine Angle into the Cavemous Sinus

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  • 小脳橋角部より海綿静脈洞部に及ぶ三叉神経鞘腫に対するcombined supra- and infratentorial transpetrosal approach

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Trigeminal neurinomas are difficult to remove when the tumors have a dumbbell configuration and extend into both the middle and posterior cranial fossa. Herein, the authors report the case of a recurrent trigeminal neurinoma which extended from the cerebello-pontine angle and prepontine space into the cavernous sinus, that was removed successfully by using a combined supra- and infratentorial transpetrosal approach (CTPA). This case involved a 45-year-old female referred to our clinic with right oculomotor, trigeminal, and facial palsy and right trigeminal neuralgia. Although a subtotal removal of the neurinoma had been performed three previous times by using a suboccipital approach, MRI revealed the tumor's recurrence. Both CT and MRI revealed that the tumor extended from right cerebello-pontine angle and prepontine space into the cavernous sinus, so that surgery was again performed, by means of a CTPA under facial nerve stimulation, and ABR and SEP monitoring. Because this was the fourth operation in this area, the anatomy was difficult to understand, and these monitors proved useful. A total removal was successfully performed. The postoperative course was uneventful, and the trigeminal neuralgia disappeared.

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