三叉神経鞘腫に対する手術戦略

Surgical Strategies for Trigeminal Schwannomas

Point

・三叉神経鞘腫は進展形式によりアプローチ選択が異なり，解剖学的理解が重要となる．

・MPE（middle, posterior, extracranial）分類を基盤とした代表的アプローチの適応と利点を整理する．

・被膜下摘出により神経温存を図り，術後合併症の回避に寄与する．

・髄液漏や静脈損傷，三叉神経心臓反射などの合併症を防ぐための具体的対策を理解する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年8月まで）。

　Trigeminal schwannomas are rare, benign tumors with diverse extension patterns along the trigeminal nerve, which significantly influence surgical approach selection. This article presents strategies for selecting optimal approaches based on tumor location, classified into middle, posterior, and extracranial compartments. Commonly used approaches include the anterior transpetrosal, epidural and interdural approaches, and recently introduced minimally invasive techniques, such as the endoscopic endonasal transmaxillary-pterygoid and transorbital approaches. The anatomical accessibility, safety, and feasibility of each technique are discussed. A detailed understanding of the trigeminal nerve's membranous anatomy, including the inner reticular layer and Meckel's cave, enables subcapsular dissection while preserving functional neural structures. This article describes practical techniques, including multilayer skull base reconstruction, venous preservation modifications, and intraoperative neurophysiological monitoring, to mitigate complications, such as venous injury, cerebrospinal fluid leakage, and cranial nerve dysfunction. Additionally, it offers a comprehensive overview of the decision-making and technical nuances essential for safe and effective resection of trigeminal schwannomas in complex skull base regions.