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The first 25 slides, exactly as they appear. The full deck has 69 content slides.
Neurosurgery
Surgical Management of Trigeminal Schwannomas
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
11 sections · 69 slides
First Principles
What the tumor is and where it grows
- What is a schwannoma?
- Meet the trigeminal nerve (cranial nerve V)
- How rare are these tumors?
- Sporadic vs syndrome-linked tumors
- Trigeminal and vestibular schwannomas in NF-2
Classification
Jefferson's anatomical scheme, and why it dictates the operation
- Why classify by location?
- Type 1 - Root type (posterior fossa)
- Small root-segment trigeminal schwannoma on MRI
- Type 2 - Ganglion type (cavernous sinus)
- Ganglion-type schwannoma in the cavernous sinus
- Type 3 - Peripheral branch type
- Type 4 - Dumbbell type (combination)
- Large dumbbell V3 schwannoma spanning fossae
- The four types at a glance
Clinical Presentation
How patients come to attention
- The sensory picture
- Pain: not the same as trigeminal neuralgia
- Double vision (diplopia)
- Hearing and facial nerve involvement
Choosing a Treatment
Watch, operate, or irradiate
- Three roads for the patient
- The case for, and limits of, surgery
- The case for radiosurgery
Preoperative Preparation
Setting up for a safe operation
- History and examination
- Imaging workup
- Medications in the operating room
- Anesthesia, lines and pressure control
- Neurophysiological monitoring
Matching Approach to Tumor
The operative paradigm
- Location-to-approach paradigm
- Guiding principles
- Planning the extradural bone removal
Frontotemporal Temporopolar Approach
An entirely extradural corridor to the cavernous sinus
- Positioning
- Incision and soft-tissue elevation
- Craniotomy options
- Extradural bone removal
- Splitting the cavernous sinus wall
- Tumor removal technique
- Intraoperative temporopolar tumor removal
- Closure and reconstruction
Anterior Transpetrosal Approach
Reaching root and posterior-fossa extension through the petrous apex
- Positioning
- Protecting the facial nerve
- Incision and craniotomy
- Dural elevation: order matters
- Petrous apex bone removal
- Opening into the posterior fossa
- Reconstruction
Postoperative Complications
What to expect and guard against
- Trigeminal dysfunction
- Keratitis: the most troublesome risk
- Diplopia and the cavernous sinus nerves
- Seventh and eighth nerve risks (transpetrosal)
Outcomes
Microsurgery, radiosurgery, and radiotherapy results
- Evolution of surgical results
- Microsurgery: the extradural shift
- Stereotactic radiosurgery: tumor control
- Radiosurgery: what the numbers show
- Radiosurgery: functional results and radiotherapy
Key Takeaways
Pulling it together
- Three things to remember
- Why does schwannoma pain usually not respond to carbamazepine the way trigeminal neuralgia does?
- Key series referenced in the chapter
- Neurosurgical Operative Atlas: Neuro-Oncology