Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma

Walid Elshamy; Burak Ozaydin; G. Mark Pyle; Mustafa K. Baskaya

doi:10.1055/s-0041-1725025

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e603-e605
DOI: 10.1055/s-0041-1725025

Skull Base: Operative Videos

Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma

Walid Elshamy

¹Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States

²Department of Neurological Surgery, Ain Shams University, Faculty of Medicine, Cairo, Egypt

,

Burak Ozaydin

¹Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States

,

G. Mark Pyle

³Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Otology/Neurotology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States

,

Mustafa K. Baskaya

⁴Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States

› Author Affiliations

Abstract

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Keywords

cavernous sinus - chordoid meningioma - Kawase's approach - Meckel's cave - transcavernous approach

Fig. 1 Preoperative axial (A) and coronal (B) T1-weighted MRI with contrast shows left-sided homogenously enhancing cavernous sinus lesion with an extension to the posterior fossa. Postoperative axial (C) and coronal (D) T1-weighted MRI with contrast shows postoperative changes and gross total resection of the lesion from the cavernous sinus with packed fat graft (arrow). MRI, magnetic resonance imaging.

Fig. 2 Cadaveric and intraoperative photomicrographs. (A) Cadaveric dissection of the cavernous sinus shows the middle meningeal artery (MMA), V2, and V3 branches of the trigeminal nerve, and greater superficial petrosal nerve (GSPN). (B) Intraoperative photomicrograph showing the incision of the membranous layer of the cavernous sinus dura between the V2 and V3 branches of the trigeminal nerve. (C) Intraoperative image of the left cavernous sinus after tumor excision shows the branches of the trigeminal nerve (V1, V2, and V3), oculomotor nerve (III), and the abducens nerve (VI) in the lateral wall of the cavernous sinus. Inset shows the cadaveric dissection of the same region. (D) Intraoperative image of the middle cranial fossa with an inset of cadaveric picture of the same region. Note the exposed petrous internal carotid artery (ICA), and the Kawase's triangle bounded by the petrous ridge, GSPN, and the V3 branch of the trigeminal nerve. MMA, middle meningeal artery.

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Figures

Fig. 1 Preoperative axial (A) and coronal (B) T1-weighted MRI with contrast shows left-sided homogenously enhancing cavernous sinus lesion with an extension to the posterior fossa. Postoperative axial (C) and coronal (D) T1-weighted MRI with contrast shows postoperative changes and gross total resection of the lesion from the cavernous sinus with packed fat graft (arrow). MRI, magnetic resonance imaging.

Fig. 2 Cadaveric and intraoperative photomicrographs. (A) Cadaveric dissection of the cavernous sinus shows the middle meningeal artery (MMA), V2, and V3 branches of the trigeminal nerve, and greater superficial petrosal nerve (GSPN). (B) Intraoperative photomicrograph showing the incision of the membranous layer of the cavernous sinus dura between the V2 and V3 branches of the trigeminal nerve. (C) Intraoperative image of the left cavernous sinus after tumor excision shows the branches of the trigeminal nerve (V1, V2, and V3), oculomotor nerve (III), and the abducens nerve (VI) in the lateral wall of the cavernous sinus. Inset shows the cadaveric dissection of the same region. (D) Intraoperative image of the middle cranial fossa with an inset of cadaveric picture of the same region. Note the exposed petrous internal carotid artery (ICA), and the Kawase's triangle bounded by the petrous ridge, GSPN, and the V3 branch of the trigeminal nerve. MMA, middle meningeal artery.