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Anterior Petrosectomy and Resection of a Meckel’s Cave Schwannoma

Contributors: Daniel Felbaum and  H. Jeff Kim

The video demonstrates the resection of a trigeminal schwannoma via a middle fossa craniiotomy and anterior petrosectomy. A large dumbbell-shaped tumor was essentially two tumors in one. The anterior petrosectomy provided access mainly to the posterior component of the tumor, which was compressing the pons, and obscured by the tentorium and petrous ridge. Mobilization of the lateral wall of the cavernous sinus freed the  anterior component and thus allowed the removal of the rest of the schwannoma.

DOI# http://dx.doi.org/10.17797/8hbvtjdj0l

Middle fossa craniotomy, anterior petrosectomy, resection of a Meckel's cave tumor
Resection of a mass lesion straddling the anterior petrous ridge, with components in both the middle and posterior fossa
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Facial nerve monitor
MRI, thin-cut CT of the temporal bone
Foramen ovale, Kawase's region, lateral wall of the cavernous sinus
Advantage: allows exposure to the anterior petrous ridge and posterior cavernous sinus Disadvantage: technically challenging, retraction on the temporal lobe
Risks include facial numbness, potential diplopia, facial palsy, seizure
Risks include facial numbness, potential diplopia, facial palsy, seizure
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