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
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.

Auteurs

Nadin J Abdala-Vargas (NJ)

Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.

Paolo Palmisciano (P)

Department of Neurosurgery, UC Davis Medical Center, Sacramento, California, USA.

Matías Baldoncini (M)

LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina.

Juan F Villalonga (JF)

LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina.
Departamento de Neurocirugía, Hospital Ángel C. Padilla, Tucumán, Argentina.

Álvaro Campero (Á)

LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina.
Departamento de Neurocirugía, Hospital Ángel C. Padilla, Tucumán, Argentina.

Classifications MeSH