Meckel's cave tumors

Relation to the meninges and minimally invasive approaches for surgery: Anatomic and clinical studies

Jun Muto, Takeshi Kawase, Kazunari Yoshida

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND: Literature on tumors originating from Meckel's cave (MC) and their surgical treatment are scarce. OBJECTIVE: We present 37 cases of tumors originating from MC, the largest single-institution series reported thus far, and discuss the ideal surgical methods for each tumor type in relation to the normal and pathological anatomy of MC. METHODS: We studied 37 cases of surgery for tumors in MC (26 schwannomas, 7 meningiomas, 2 epidermoids, 1 hemangiopericytoma, and 1 dermoid) performed at our institution between 1986 and 2008. We excluded cases of large tumors of unknown origin, especially meningiomas. Surgery for tumors in MC was performed via 2 approaches: anterolateral interdural access (Dolenc's) approach and posterior access via the anterior petrosal approach (APA). RESULTS: The Dolenc approach was useful for parasellar tumors, especially schwannomas, because it resulted in minimal damage to the temporal lobe and adjacent cranial nerves. The APA was useful for dumbbell-shaped tumors extending into the posterior fossa. Tumors of nonmeningeal origin (schwannomas, epidermoids, and dermoids) were safely resected, with no postoperative complications except facial hypesthesia. However, incidence of postsurgical paresthesia and abducens palsy were higher in meningioma and hemangiopericytoma, because of invasion into the Gasserian ganglion, the cavernous sinus (CS), or Dorello's canal. CONCLUSION: An understanding of meningeal structure around MC enhances the radicality of tumor resection and helps minimize damage to adjacent structures. However, meningiomas and hemangiopericytomas occurring in MC, which can infiltrate into the CS, should be treated by both surgery and radiosurgery to minimize postoperative complications.

Original languageEnglish
JournalNeurosurgery
Volume67
Issue numberSUPPL. 1
DOIs
Publication statusPublished - 2010 Dec

Fingerprint

Meninges
Minimally Invasive Surgical Procedures
Meningioma
Neoplasms
Hemangiopericytoma
Neurilemmoma
Dermoid Cyst
Cavernous Sinus
Clinical Studies
Trigeminal Ganglion
Hypesthesia
Radiosurgery
Cranial Nerves
Paresthesia
Temporal Lobe
Anatomy

Keywords

  • Anterior petrosal approach
  • Dolenc's approach
  • Meckel's cave
  • Meningiomas
  • Schwannomas

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Meckel's cave tumors : Relation to the meninges and minimally invasive approaches for surgery: Anatomic and clinical studies. / Muto, Jun; Kawase, Takeshi; Yoshida, Kazunari.

In: Neurosurgery, Vol. 67, No. SUPPL. 1, 12.2010.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Literature on tumors originating from Meckel's cave (MC) and their surgical treatment are scarce. OBJECTIVE: We present 37 cases of tumors originating from MC, the largest single-institution series reported thus far, and discuss the ideal surgical methods for each tumor type in relation to the normal and pathological anatomy of MC. METHODS: We studied 37 cases of surgery for tumors in MC (26 schwannomas, 7 meningiomas, 2 epidermoids, 1 hemangiopericytoma, and 1 dermoid) performed at our institution between 1986 and 2008. We excluded cases of large tumors of unknown origin, especially meningiomas. Surgery for tumors in MC was performed via 2 approaches: anterolateral interdural access (Dolenc's) approach and posterior access via the anterior petrosal approach (APA). RESULTS: The Dolenc approach was useful for parasellar tumors, especially schwannomas, because it resulted in minimal damage to the temporal lobe and adjacent cranial nerves. The APA was useful for dumbbell-shaped tumors extending into the posterior fossa. Tumors of nonmeningeal origin (schwannomas, epidermoids, and dermoids) were safely resected, with no postoperative complications except facial hypesthesia. However, incidence of postsurgical paresthesia and abducens palsy were higher in meningioma and hemangiopericytoma, because of invasion into the Gasserian ganglion, the cavernous sinus (CS), or Dorello's canal. CONCLUSION: An understanding of meningeal structure around MC enhances the radicality of tumor resection and helps minimize damage to adjacent structures. However, meningiomas and hemangiopericytomas occurring in MC, which can infiltrate into the CS, should be treated by both surgery and radiosurgery to minimize postoperative complications.

AB - BACKGROUND: Literature on tumors originating from Meckel's cave (MC) and their surgical treatment are scarce. OBJECTIVE: We present 37 cases of tumors originating from MC, the largest single-institution series reported thus far, and discuss the ideal surgical methods for each tumor type in relation to the normal and pathological anatomy of MC. METHODS: We studied 37 cases of surgery for tumors in MC (26 schwannomas, 7 meningiomas, 2 epidermoids, 1 hemangiopericytoma, and 1 dermoid) performed at our institution between 1986 and 2008. We excluded cases of large tumors of unknown origin, especially meningiomas. Surgery for tumors in MC was performed via 2 approaches: anterolateral interdural access (Dolenc's) approach and posterior access via the anterior petrosal approach (APA). RESULTS: The Dolenc approach was useful for parasellar tumors, especially schwannomas, because it resulted in minimal damage to the temporal lobe and adjacent cranial nerves. The APA was useful for dumbbell-shaped tumors extending into the posterior fossa. Tumors of nonmeningeal origin (schwannomas, epidermoids, and dermoids) were safely resected, with no postoperative complications except facial hypesthesia. However, incidence of postsurgical paresthesia and abducens palsy were higher in meningioma and hemangiopericytoma, because of invasion into the Gasserian ganglion, the cavernous sinus (CS), or Dorello's canal. CONCLUSION: An understanding of meningeal structure around MC enhances the radicality of tumor resection and helps minimize damage to adjacent structures. However, meningiomas and hemangiopericytomas occurring in MC, which can infiltrate into the CS, should be treated by both surgery and radiosurgery to minimize postoperative complications.

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