case_images: PMC10771842_01
case_images: Schematic representation of the timeline from presentation and primary surgery through the recurrence of the lesion and the second operation.
case_images: fsurg-10-1278177-g001.jpg
case_images: PMC10771842_01_fsurg-10-1278177-g001.jpg
case_images: F1
case_images: Examination revealed normal neurologic findings and no focal deficits (Figure 1).
case_images: (A) Axial contrast enhanced T1-weighted image showing a lesion in the left trigeminal nerve extending from pontine portion into Meckel's cave. (B) shows interval image at 1 year after presentation which showed involution of the lesion. (C, D), show new hemorrhage with cystic portion invaginating the brainstem which prompted surgical intervention. (E, F) show 6-month postoperative contrast enhanced T1-weighted axial and coronal images, respectively, after the first operation via retrosigmoid approach demonstrating gross total resection.
case_images: fsurg-10-1278177-g002.jpg
case_images: PMC10771842_01_fsurg-10-1278177-g002.jpg
case_images: F2
case_images: She initially underwent a period of surveillance during which time the lesion involuted at 1 year (Figure 2). Postoperative images showed gross total resection with no evidence of radiological recurrence at 12 months (Figure 2).
case_images: Shows images before and after the second operation via a subtemporal Kawase-Dolenc approach. (A) contrast enhanced T1-weighted imaging and (B) Susceptibility weighted image demonstrate the lesion filling Meckel's cave extending along the cisternal segment of the trigeminal nerve and invaginating the brain. (C) demonstrates the coronal FLAIR that shows the CM involving the brainstem and extending down to the internal acoustic meatus. (D,E) are contrast-enhanced T1, and T2-weighted images, respectively, and (F) is a coronal FLAIR that demonstrate complete resection of the recurrent lesion.
case_images: fsurg-10-1278177-g003.jpg
case_images: PMC10771842_01_fsurg-10-1278177-g003.jpg
case_images: F3
case_images: MRI revealed considerable recurrence of the lesion along the anatomical extent of the trigeminal nerve which distorted the ventrolateral brainstem, middle cerebellar peduncle (MCP) and extended into the Meckel's cave and caudally below the trigeminal nerve toward the internal acoustic canal (Figure 3).
case_images: (A) axial and (B) coronal CT images demonstrating the extent of the anterior petrosectomy to give access to the lesion during the Kawase-Dolenc approach at the second operation.
case_images: fsurg-10-1278177-g004.jpg
case_images: PMC10771842_01_fsurg-10-1278177-g004.jpg
case_images: F4
case_images: Key operative steps included a frontotemporal craniotomy with an anterior interdural approach to the mandibular nerve then posterior dural elevation to undertake anterior petrosectomy (Figure 4).