Cranio-orbital zygomatic extradural approachによる海綿静脈洞部およびMeckel腔腫瘍の摘出

Cranio-orbital zygomatic extradural approach for cavernous sinus or Meckel's cave tumors

I．はじめに

　近年，海綿静脈洞部腫瘍に対する直達手術が行われるようになってきた^{1,2,7,8,11,13,14,17,23-25）}．われわれは主にcranio-orbital zygomatic approach（C-O—Z：Al-Mefty）^1,2）により海綿静脈洞部腫瘍の手術を行っている．そのうち，術前MRI所見から海綿静脈洞に限局し硬膜内進展がないと判断した腫瘍に対しては^10），より侵襲の小さな硬膜外操作のみで腫瘍摘出を試み，海綿静脈洞部腫瘍11例中4例で満足な成績を得た．海綿静脈洞部腫瘍に対する硬膜外アプローチの方法と症例を報告する．

Direct surgry to cavernous sinus (CS) lesions has be-come one of the optimal treatments based on advance-ment in microsurgical anatomy and imaging modality, and the progress of microsurgical techniques.

We have removed the CS or Meckel's cave tumors extradurally when they do not extend intradurally, us-ing modified Al-Mefty's cranio-orbital zygomatic cra-niotomy. Three CS tumors;trigeminal neurofibroma, squamous cell carcinoma and chondrosarcoma, and a Meckel's cave meningioma were reported. Total remov-al was achieved in all but one (case 4). Postoperative complications were permanent ophthalmoplegia in one, transient ophthalmoplegia in one, subcutaneous CSF accumulation in two and trigeminal dysfunction in one.The extradural approach can be the first choice of methods for total removal of tumors when they are confined to the CS or Meckel's cave.