Three-Stage Surgical Resection in Semisitting Position of Sphenocavernopetroclival-Foramen Magnum Meningioma: 3-Dimensional Operative Video.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
16 Apr 2024
16 Apr 2024
Historique:
received:
16
10
2023
accepted:
08
02
2024
medline:
16
4
2024
pubmed:
16
4
2024
entrez:
16
4
2024
Statut:
aheadofprint
Résumé
Large meningiomas extending through the middle cranial fossa, posterior fossa, and foramen magnum (FM) represent a surgical challenge even for experienced skull base surgeons.1 Although decompression may be necessary for offering clinical improvement, surgical risks may involve cranial nerves and vascular injury. We present a case of a sphenocavernopetroclival-FM meningioma, with our surgical plan extending through the sphenoid region, FM, and posterior fossa to the anterior arch of C1. We designed a 2-day, 3-stage surgical strategy to achieve complete surgical resection for offering better long-term prognosis and satisfactory postoperative neurological outcome.2 The surgical plan was completed in 2 days of surgery: the first day the extradural part for achieving optimal tumor exposure and the second day the intradural part to tackle tumor resection in a 3-stage fashion. The first stage consisted in a far lateral approach to access the lower portion of the tumor extending from the FM to the spinal region; the second stage focused on the portion of the tumor extending through the inferior clivus and the petroclival region; and the third stage consisted in resecting the tumor extending from the petroclival region to the sphenoid region.3 A near-total resection was achieved, with a very small tumor remnant observed at the level of the tentorium on postoperative MRI, which was treated with radiosurgery owing to the young age of the patient. This is a 3-dimensional operative video showing the surgical steps of the tumor resection. The patient consented to the procedure and to the publication of her image.
Identifiants
pubmed: 38624202
doi: 10.1227/ons.0000000000001163
pii: 01787389-990000000-01120
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2024. All rights reserved.
Références
Nguyen MP, Morshed RA, Cheung SW, Theodosopoulos PV, McDermott MW. Postoperative complications and neurological deficits after petroclival region meningioma resection: a case series. Oper Neurosurg. 2023;25(3):251-259.
da Silva CE, de Freitas PE. Large and giant skull base meningiomas: the role of radical surgical removal. Surg Neurol Int. 2015;6:113.
Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus. 2013;35(6):E12.