Introduction
Methods
PRISMA literature search protocol
Results
Approaches to Meckel’s cave in the literature (Fig. 1)
Antero-medial
Transpterygoid approach
Illustrative case
Transmaxillary
Transorbital
Percutaneous
Anterolateral and lateral approaches
Subtemporal transpetrosal-transtentorial approach with anterior petrosectomy (Kawase-Shiobara approach)
Postero-lateral
Retrosigmoid intradural suprameatal approach
Other approaches
Discussion
Differential diagnosis of lesions in Meckel’s cave
Decision-making
Benign | Meningioma [61] |
Benign Schwannoma [61] | |
Benign melanotic schwannoma [99] | |
Xanthoma [100] | |
Lipoma [61] | |
Neuromuscular hamartoma [33] | |
Hemangioblastoma [27] | |
Cavernous hemangioma [63] | |
Pituitary adenoma [63] | |
Malignant | Malignant peripheral nerve sheet tumor [63] |
Primary | Nasal glioma [25] |
Atypical teratoid-rhabdoid [20] | |
Intradural chordoma [15] | |
Chondrosarcoma [63] | |
Paraganglioma [30] | |
Rhabdomyosarcoma [63] | |
Metastatic | |
Neuroendocrine carcinoma [63] | |
Adenoid cystic carcinoma [5] | |
Squamous cell carcinoma [63] | |
Adenocarcinoma [63] | |
Inflammatory | |
IgG4 disease [63] | |
Necrotizing granulomatous inflammation [63] | |
Inflammatory pseudotumor [63] | |
Hematologic malignancies | Primary malignant lymphoma [26] |
Multiple myeloma [32] | |
NK/T lymphoma [63] | |
Diffuse B-cell lymphoma* | |
Plasmacytoma [63] | |
Marginal zone lymphoma [63] | |
Chronic eosinophilic leukemia [63] | |
Lymphoplasmocytic lymphoma [63] | |
Non-Hodgkin lymphoma [63] | |
Cystic | |
Meningoceles [102] |
Portion MC access | Advantages | Structures at risk/complications | Limits | ||
---|---|---|---|---|---|
Anterio-medial | Transpterygoid | Antero-medial inferior | No brain retraction | CSF leak, vidian nerve/artery, corneal keratopathy, internal carotid artery | Content infratemporal fossa, region lateral and posterior to the GG |
Transantral/-maxillary | Antero-lateral | Less ICA/PPF manipulation | Oro-antral fistula, nasolacrimal duct | Posterior fossa | |
Transorbital | Superior and anterolateral | Limited temporal retraction, no manipulation of PPF content | Orbital content, cranial nerves, M. levator palpebrae, CSF leak and pulsatile exopthalmus | Region medial to V1, posterior to ICA | |
Percutaneous | Foramen rotundum | Minimal invasive | Internal maxillary artery, cranial nerves, e.g. trigeminal and oculomotor nerves | Lack of surgical field visualization | |
Antero-lateral | Pterional and orbitozygomatic extension | Antero-lateral-superior | Standard skull base surgery approach | Cranial nerve injury (III, IV, VI), temporal muscle disruption/translocation brain retraction | Inferior portion of MC |
Lateral | Anterior petrosectomy | Lateral, dorsal | Posterior fossa extension, if required | Brain retraction, wide craniotomy, tentorial division, otologic structures, superior petrosal vein | Lower edge porus trigeminus, petrous ICA, inferior petrosal vein |
Posterior | Retrosigmoid-suprameatal | Dorso-medial | Small craniotomy | Cranial nerve injury (VII-VIII), sinus sigmoideus, cerebellum retraction | Middle fossa |