Abstract
When operating on difficult skull base lesions, it is essential to be able to handle
unexpected intraoperative findings or troubles, while achieving maximal lesion removal
and minimal functional deficit. This video demonstrates a case of trochlear nerve
repair that was performed during the retrosigmoid suprameatal approach for treatment
of a petrotentorial meningioma, extending into the Meckel's cave. The patient is a
47-year-old woman with a right petrotentorial meningioma, extending into the Meckel's
cave. The retrosigmoid suprameatal approach was performed with preservation of the
superior petrosal vein. However, a divided trochlear nerve was incidentally found
during tumor resection. We hence carefully dissected both nerve ends from the tumor
without shortening their lengths, and repaired them by end-to-end anastomosis, using
fibrin glue without any graft materials. The tumor was removed completely and the
patient's preoperative facial sensory impairment disappeared after the surgery. The
patient's facial sensory impairment disappeared completely, but she had transient
diplopia after the surgery. However, the newly developed diplopia resolved completely,
and she had no neurological deficits or tumor recurrence during the follow-up period
of 1-year.
The link to the video can be found at: https://youtu.be/g-B-w_zDudg.
Keywords
cerebellopontine angle - cranial nerve anastomosis - nerve reconstruction - nerve
regeneration - skull base surgery
