Imaging-Ambiguous Lesions of Meckel's Cave-Utility of Endoscopic Endonasal Transpterygoid Biopsy.

Document Type

Article

Publication Date

6-30-2018

Publication Title

World Neurosurg

Keywords

Cavernous sinus; Endoscopic; Gasserian ganglion; Meckel's cave; Perineural spread; Transpterygoid; Transsphenoidal; Adenocarcinoma/diagnostic imaging Adenocarcinoma/surgery Carcinoma, Squamous Cell/diagnostic imaging Carcinoma, Squamous Cell/surgery Central Nervous System Diseases/diagnostic imaging Central Nervous System Diseases/surgery Cranial Fossa, Middle/diagnostic imaging Cranial Fossa, Middle/surgery* Female Humans Lymphoma, B-Cell/diagnostic imaging Lymphoma, B-Cell/surgery Male Middle Aged Nasal Cavity/diagnostic imaging Nasal Cavity/surgery* Neurilemmoma/diagnostic imaging Neurilemmoma/surgery Neuroendoscopy/methods* Pterygoid Muscles/diagnostic imaging Pterygoid Muscles/surgery* Retrospective Studies Sarcoidosis/diagnostic imaging Sarcoidosis/surgery Skull Base Neoplasms/diagnostic imaging Skull Base Neoplasms/surgery

Abstract

INTRODUCTION: Meckel's cave is a dural-lined cavity in the middle fossa skull base in which lies the Gasserian ganglion, a potential site for tumors and inflammatory lesions. A variety of lesions can be predominantly isolated to Meckel's cave, including extension from head and neck cancers, other malignant tumors, as well as benign lesions. Clinical presentation and imaging findings are often insufficient to establish a diagnosis. Hence, histologic confirmation is required to determine the appropriate treatment strategy. Several surgical approaches have been used to reach this deep-seated area, often with significant morbidity and prolonged recovery. Given advancements in endoscopy and greater facility with the technique, the endoscopic endonasal approach has been used increasingly to reach lesions in the region.

METHODS: A single-institution, retrospective chart review over a 10-year period was performed to identify and describe patients with pathologically differing but imaging-similar lesions with their epicenter in Meckel's cave.

RESULTS: Of a total of 21 cases of lesions in Meckel's cave approached by an endoscopic endonasal transpterygoid approach, we present 6 patients with imaging-ambiguous lesions involving Meckel's cave that were biopsied via the extended endoscopic endonasal approach. Among this diverse group, pathology included B-cell lymphoma, squamous cell carcinoma, adenocarcinoma, malignant schwannoma, benign schwannoma, and neurosarcoidosis.

CONCLUSIONS: We explore not only the relevance of this approach in the armamentarium of the modern skull-base surgeon but also its limitations and conclude that the endoscopic endonasal approach provides a safe and relatively direct, minimally invasive corridor to many lesions of Meckel's cave.

Clinical Institute

Cancer

Clinical Institute

Neurosciences (Brain & Spine)

Department

Oncology

Department

Neurosciences

Department

Surgery

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