Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence

2009 ◽  
Vol 152 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Tadashige Kano ◽  
Takeshi Kawase ◽  
Takashi Horiguchi ◽  
Kazunari Yoshida
Keyword(s):  
Foramen Magnum ◽  
Tumour Recurrence ◽  
Tumour Resection ◽  
Surgical Morbidity ◽  
Factors Influencing ◽  
Lower Clivus

Surgical approaches to posterior fossa tumours

2019 ◽  
pp. 375-382
Author(s):  
Jacques J. Morcos ◽  
Osaama Khan ◽  
Ashish H. Shah
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Surgical Techniques ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Tumour Resection ◽  
Surgical Morbidity ◽  
Preoperative Workup ◽  
Lower Cranial Nerves

Lesions of the fourth ventricle and foramen magnum can be difficult to manage surgically due to their proximity to critical brainstem structures. Understanding the anatomy of the fourth ventricle, lower cranial nerves, and basilar cisterns remains paramount for deciding surgical approaches to this location. Detailed preoperative workup and planning are necessary to minimize surgical morbidity and maximize tumour resection. This chapter provides an overview of the relevant anatomy and surgical techniques for lesions in the posterior fossa, specifically the fourth ventricle the foramen magnum. We will split this chapter into two main sections: microsurgical approaches to the fourth ventricle and skull base approaches to the foramen magnum.

Surgical Treatment of Chiari I Malformation—Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 365-380 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Clinical Symptoms ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Outcome Data ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Surgical Morbidity ◽  
Suboccipital Craniectomy ◽  
Chiari I

Abstract BACKGROUND: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial. OBJECTIVE: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes. METHODS: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics. RESULTS: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years. CONCLUSION: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.

scholarly journals Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches

2003 ◽  
Vol 14 (6) ◽  
pp. 1-5 ◽  
Author(s):  
Agustinus Suhardja ◽  
Anne M. R. Agur ◽  
Michael D. Cusimano
Keyword(s):  
Anatomical Study ◽  
Foramen Magnum ◽  
The Other ◽  
Retrosigmoid Approach ◽  
Surface Areas ◽  
Anatomical Basis ◽  
Paired Student ◽  
The Mean ◽  
Lower Clivus ◽  
The Brain

Object Meningiomas of the lower clivus and foramen magnum are among the most challenging of all neurosurgical lesions. Debate continues regarding the most appropriate approach to this eloquent anatomical region. This anatomical study was undertaken to measure and compare the area of surgical exposures of the lower clivus achieved using the retrosigmoid and the extreme-lateral transcondylar (ELT) approaches. Methods Thirteen embalmed cadaveric heads were dissected bilaterally via the retrosigmoid approach on one side and the ELT approach on the other. The circumference of the area of exposure was delineated using beaded pins placed into the dura. After removal of the brain, the longest longitudinal and transverse axes of the pinned areas were measured and surface area calculated. The area of surgical exposure was also expressed as a percentage of the total area of the lower clivus. Normalized and adjusted surface areas were calculated using the bimastoid diameter. The areas of exposure were compared using the two-tailed paired Student t-test. The mean area of exposure required using the retrosigmoid approach was 19.8 ±14.7 mm2 (range 6–49 mm2) and that using the ELT approach was 27.8 ±22.8 mm2 (range 10–90 mm2). The mean percentage of the lower clivus exposed by the retrosigmoid approach was 14.9 ±3.6% (range 10–22%) and that exposed by the ELT approach was 20.5 ± 4.9% (range 10–25%). The ELT approach provided significantly greater area of operative exposure and allowed a significantly higher percentage of lower clivus and foramen magnum exposure than did the retrosigmoid approach (p <0.05). Normalized and adjusted surface areas, taking into consideration the bimastoid diameter, were also statistically significant in favor of the ELT approach. Conclusions The ELT approach provided a significantly greater area of exposure than did the retrosigmoid approach.

FORAMEN MAGNUM MENINGIOMAS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1177-1187 ◽  
Author(s):  
Hischam Bassiouni ◽  
Vasilios Ntoukas ◽  
Siamak Asgari ◽  
Erol I. Sandalcioglu ◽  
Dietmar Stolke ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Consecutive Series ◽  
Surgical Morbidity ◽  
Simpson Grade ◽  
Dural Attachment ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Tumor Remnant

Abstract OBJECTIVE We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome. METHODS Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed. RESULTS The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1–14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity. CONCLUSION Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.

scholarly journals Diaphragmatic Peritonectomy versus Full Thickness Diaphragmatic Resection and Pleurectomy during Cytoreduction in Patients with Ovarian Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
P. N. J. Pathiraja ◽  
R. Garruto-Campanile ◽  
R. Tozzi
Keyword(s):  
Pleural Effusion ◽  
Residual Disease ◽  
University Hospital ◽  
Tumour Resection ◽  
Effusion Rate ◽  
Full Thickness ◽  
Surgical Morbidity ◽  
Surgical Interventions ◽  
Group 2 ◽  
Group 1

Objectives. Compare the surgical morbidity of diaphragmatic peritonectomy versus full thickness diaphragmatic resection with pleurectomy at radical debulking.Design. Prospective cohort study at the Oxford University Hospital.Methods. All debulking with diaphragmatic peritonectomy and/or full thickness resection with pleurectomy in the period from April 2009 to March 2012 were part of the study. Analysis is focused on the intra- and postoperative morbidity.Results. 42 patients were eligible for the study, 21 underwent diaphragmatic peritonectomy (DP, group 1) and 21 diaphragmatic full thickness resection (DR, group 2). Forty patients out of 42 (93%) had complete tumour resection with no residual disease. Histology confirmed the presence of cancer in diaphragmatic peritoneum of 19 patients out of 21 in group 1 and all 21 patients of group 2. Overall complications rate was 19% in group 1 versus 33% in group 2. Pleural effusion rate was 9.5% versus 14.5% and pneumothorax rate was 14.5% only in group 2. Two patients in each group required postoperative chest drains (9.5%).Conclusions. Diaphragmatic surgery is an effective methods to treat carcinomatosis of the diaphragm. Patients in the pleurectomy group experienced pneumothorax and a higher rate of pleural effusion, but none had long-term morbidity or additional surgical interventions.

“Lazy” far-lateral approach to the anterior foramen magnum and lower clivus

2015 ◽  
Vol 38 (4) ◽  
pp. E14 ◽  
Author(s):  
Samuel Moscovici ◽  
Felix Umansky ◽  
Sergey Spektor
Keyword(s):  
Foramen Magnum ◽  
Lateral Approach ◽  
Anatomical Structure ◽  
Lateral Mass ◽  
Surgical Mortality ◽  
Bone Removal ◽  
Working Space ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Lower Clivus

The far-lateral approach (FLA) has become a mainstay for skull base surgeries involving the anterior foramen magnum and lower clivus. The authors present a surgical technique using the FLA for the management of lesions of the anterior/ anterolateral foramen magnum and lower clivus. The authors consider this modification a “lazy” FLA. The vertebral artery (VA) is both a critical anatomical structure and a barrier that limits access to this region. The most important nuance of this FLA technique is the management of this critical vessel. When the lazy FLA is used, the VA is reflected laterally, encased in its periosteal sheath and wrapped in the dura, greatly minimizing the risk for vertebral injury while preserving a wide working space. To accomplish this step, drilling is performed lateral to the point where the VA pierces the dura. The dura is incised medial to the VA entry point by using a slightly curved longitudinal cut. Drilling of the condyle and the C-1 lateral mass is performed in a manner that preserves craniocervical stability. The lazy FLA is a true FLA that is based on manipulation of the VA and lateral bone removal to obtain excellent exposure ventral to the spinal cord and medulla, yet it is among the most conservative FLA techniques for management of the VA and provides a safer window for bone work and lesion management. Among 44 patients for whom this technique was used to resect 42 neoplasms and clip 2 posterior inferior cerebral artery aneurysms, there was no surgical mortality and no injury to the VA.

scholarly journals C1 Hemilaminectomy for Resection of Foramen Magnum Meningioma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Stefan Lieber ◽  
Rocio Evangelista-Zamora ◽  
Maximiliano Nunez ◽  
Marcos Tatagiba
Keyword(s):  
Cranial Nerves ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
World Health ◽  
Proliferation Index ◽  
Tectorial Membrane ◽  
Who Grade ◽  
Invasive Approach ◽  
Health Organization ◽  
Lower Clivus

AbstractWe present a case of a sizeable foramen magnum meningioma that was resected through a C1 hemilaminectomy in prone (concorde) position. The patient is a 51-year-old woman with a 3-month history of progressive paresthesia of the upper and lower extremities, followed by gait disturbance, and hand apraxia. There was no complaint of nuchal pain.On magnetic resonance imaging (MRI) a briskly enhancing extra-axial, intradural craniospinal lesion, extending from the basion of the lower clivus, over the tectorial membrane to the middle of the axis' body was discovered. There was significant transposition and compression of the medulla and corresponding focal hyperintensity on T2-weighted imaging.On physical examination, the patient was ambulatory independently, notwithstanding a pronounced spinal ataxia. There were deficits in sensation and proprioception, as well as urinary retention, but preserved function of the lower cranial nerves.In view of the profound transposition of the medulla, utilization of the corridor created by the tumor seemed feasible and we felt that a limited C1 hemilaminectomy would provide sufficient microsurgical access thus obviating a more extensive and invasive approach to the craniocervical junction.A gross-total resection was achieved; histopathology confirmed a World Health Organization (WHO) grade I angiomatous meningioma with a low-proliferation index. The patient was discharged home 3 days after surgery and her spinal ataxia resolved completely within 3 months of out-patient rehabilitation. At 3-year follow-up, there was no indication of residual or recurrence.The link to the video can be found at: https://youtu.be/WyShbfr-xi0.

Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 888-897 ◽  
Author(s):  
Ali Kooshkabadi ◽  
Phillip A. Choi ◽  
Maria Koutourousiou ◽  
Carl H. Snyderman ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Open Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Combined Approach ◽  
Endoscopic Endonasal ◽  
Primary Bone Tumors ◽  
Far Lateral Approach ◽  
Lower Clivus ◽  
Occipital Condyles

BACKGROUND: The endoscopic endonasal approach (EEA) for craniocervical lesions involving the lower clivus and occipital condyles carries an unclear risk of atlanto-occipital (AO) instability requiring arthrodesis. OBJECTIVE: Elucidate risk factors for AO instability following EEA for clival lesions. METHODS: We reviewed patients with clival tumors who underwent EEA at our institution between 2002 and 2012. Resection of the lower clivus, foramen magnum, AO joint, and occipital condyles were evaluated on fine-cut postoperative computed tomography. RESULTS: Two hundred twelve patients (mean age 47.9 years, 57.1% male) underwent transclival EEA for lower clival lesions. In addition to the lower clivus, resection involved the condyle in 14.2% of patients, the foramen magnum in 16.5%, and the AO joint in 1.4%. Quantification of condyle resection revealed complete resection in 3 cases, 75% resection in 8 cases, 50% resection in 6 cases, and 25% resection in 13 cases. Seven of these patients had EEA combined with an open, far-lateral approach. In total, 7 patients required arthrodesis following EEA (3.3%), 4 of them after a combined approach. All patients who underwent arthrodesis had primary bone tumors such as chordoma, chondrosarcoma, or osteosarcoma (P = .022). Degree of condyle resection was a significant factor predisposing to occipitocervical instability (P = .001 and P &lt; .001 for 75% and 100% condyle resection, respectively). Use of a combined approach was significantly associated with arthrodesis (P &lt; .001). CONCLUSION: EEA resection of the occipital condyles that results in greater than 75% condyle resection or EEA in combination with an open approach significantly increases the risk of AO instability and likely necessitates AO fixation.

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