scholarly journals Low Subfrontal Dural Opening for Anterior Clinoid Meningioma

2018 ◽  
Vol 79 (S 03) ◽  
pp. S273-S275
Author(s):  
Michael Chicoine
Keyword(s):  
Optic Nerve ◽  
Surgical Technique ◽  
Vision Loss ◽  
Tumor Resection ◽  
Postoperative Recovery ◽  
Vascular Lesions ◽  
Optic Canal ◽  
The Novel ◽  
Dural Opening ◽  
Brain Retraction

Introduction A variety of dural openings are described for frontal–temporal and cranio-orbital craniotomies. As with any surgical technique, the goal is to optimally and safely address the pathology, minimize normal anatomy disruption, and optimize postoperative recovery. This study reports a modified dural opening for frontal–temporal approaches which minimizes brain exposure while facilitating visualization for neoplastic and vascular lesions of the anterior clinoid, supra- and parasellar and adjacent regions. Methods A sample case is presented for which a low subfrontal dural exposure was utilized for tumor resection. The clinical presentation, surgical procedure, and outcome are summarized including a video detailing the surgical technique. Results A 63-year-old female with gradual left eye vision loss and tumor enlargement on serial imaging. The small dural-based tumor arose from the left anterior clinoid and optic canal region compressing the optic nerve. The video shows a left frontal–temporal craniotomy used to perform extradural anterior clinoidectomy and optic canal decompression. The novel low subfrontal dural opening without fixed brain retraction allowed dural opening around the optic canal and clinoidectomy region to resect tumor and complete optic nerve decompression. Postoperatively, the patient did well with significant recovery of vision and follow-up at 2.5 years shows no evidence of tumor recurrence. Conclusion The novel low subfrontal dural opening provides access to lesions of the supra-and para-sellar and adjacent regions, and preservation of much of the dura avoids some of the risks of intradural dissection including Sylvian fissure dissection and brain retractionThe link to the video can be found at: https://youtu.be/Jc7wvR4PTFk.

scholarly journals Contralateral Eyebrow Approach for Unilateral Suprasellar Meningioma

2018 ◽  
Vol 79 (S 02) ◽  
pp. S215-S217
Author(s):  
Sorin Aldea ◽  
Stéphan Gaillard
Keyword(s):  
Optic Nerve ◽  
Visual Loss ◽  
Complete Removal ◽  
Optic Canal ◽  
Line Of Sight ◽  
Visual Recovery ◽  
Postoperative Mri ◽  
Working Distance ◽  
Dural Opening ◽  
Distinct Features

AbstractUnilateral suprasellar meningiomas have distinct features compared to other midline tumors, as they may produce severe visual symptoms even if small due to an early involvement of the optic canal. Surgical treatment of these tumors from an ipsilateral approach is challenging, as the tumor is covered by the optic nerve that needs to be mobilized to access the optic canal extension. A contralateral approach allows a direct line of sight to the tumor despite a longer working distance. We report the case of a 49-year-old patient presenting with unilateral visual loss related to a left suprasellar meningioma extending to the left optic canal and displacing the optic nerve laterally. Through a right eyebrow approach, a 2.5/2 cm supraorbital bone flap was raised and the orbital floor was thoroughly flattened. After dural opening, the carotid cistern was opened and CSF evacuated allowing a surgery without fixed retractors. The intracranial part of the tumor was removed, but the optic nerve seemed to be still displaced by the intracanalicular part. Under copious irrigation, the medial part of the optic canal was drilled, the dura incised, and the tumor removed. Postoperative course was favorable and the patient made a complete visual recovery. Postoperative MRI showed complete removal of the tumor. We present different surgical steps and discuss the nuances of the procedure. The contralateral eyebrow approach is an interesting addition to the surgical armamentarium and should be discussed for unilateral suprasellar tumors.The link to the video can be found at: https://youtu.be/2LTEOaGoKzo.

EFFECT OF EARLY OPTIC CANAL UNROOFING ON THE OUTCOME OF VISUAL FUNCTIONS IN SURGERY FOR MENINGIOMAS OF THE TUBERCULUM SELLAE AND PLANUM SPHENOIDALE

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 839-846 ◽  
Author(s):  
Kazuhiko Nozaki ◽  
Ken-ichiro Kikuta ◽  
Yasushi Takagi ◽  
Youhei Mineharu ◽  
Jun A. Takahashi ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Tumor Size ◽  
Tumor Resection ◽  
Optic Canal ◽  
Visual Symptoms ◽  
Tuberculum Sellae ◽  
The Mean ◽  
Planum Sphenoidale ◽  
Tumor Consistency ◽  
Optic Canal Unroofing

Abstract OBJECTIVE The aim of this study was to evaluate the effect of early optic canal unroofing on visual function in patients with meningiomas of the tuberculum sellae and planum sphenoidale. METHODS We retrospectively reviewed the clinical records of 20 consecutive patients with tuberculum sellae meningiomas and two patients with planum sphenoidale meningiomas who were admitted to our institution from 1999 to 2007. Factors that may influence postoperative visual functions were analyzed, including patient's age and sex, duration of preoperative visual symptoms, preoperative visual acuity, tumor size, tumor consistency, tumor extension into the optic canal, tumor adhesion to the optic nerve, timing of optic canal unroofing, and tumor resection rate. RESULTS The mean patient age was 52.9 ± 13.7 years (range, 27–73 yr); 18 patients were women and four were men. The mean maximum tumor size was 2.3 ± 0.7 cm (range, 1.5–3.5 cm). Visual symptoms were present preoperatively in 19 patients, and three patients were asymptomatic. The mean duration of visual symptoms was 12.0 ± 16.4 months (range, 0–72 mo). Tumor resection was evaluated according to Simpson's grade, and Grade II was achieved in 14, Grade III in two, and Grade IV in six (two patients were recurrent cases). Tumors were extended into the optic canal in 15 patients, and severe adhesion to the optic nerve was observed in nine patients. Tumor consistency was soft in eight patients, intermediate in eight patients, and hard in six patients. The optic canal was unroofed early before dissection or manipulation of tumor in nine patients (early group) and after dissection of tumor in seven patients (late group), and optic canal unroofing was not performed in six patients (none group; no canal extension in two and intentional incomplete resection in four patients). Visual symptoms were improved in 10 patients, unchanged in seven patients, and worsened in five patients (transient in two and permanent in three). Logistic regression analysis revealed that early optic canal unroofing was an independent factor for postoperative improvement of visual symptoms. CONCLUSION Early optic canal unroofing may increase the possibility of improved preoperative visual symptoms in surgical resection of tuberculum sellae meningiomas and planum sphenoidale meningiomas.

scholarly journals Prognostic factors in the surgical treatment of intracanalicular primary optic nerve sheath meningiomas

2019 ◽  
Vol 131 (2) ◽  
pp. 481-488 ◽  
Author(s):  
Marcio S. Rassi ◽  
Sashank Prasad ◽  
Anil Can ◽  
Svetlana Pravdenkova ◽  
Rami Almefty ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Surgical Treatment ◽  
Optic Nerve ◽  
Vision Loss ◽  
Tumor Resection ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Objective Evidence

OBJECTIVEAlthough meningiomas frequently involve the optic nerve, primary optic nerve sheath meningiomas (ONSMs) are rare, accounting for only 1% of all meningiomas. Given the high risk of vision loss with these tumors, surgical intervention is seldom considered, and radiation or observation is commonly applied. Here, the authors describe the visual outcomes for a series of patients who were treated with surgery aiming at maximal tumor resection and highlight their prognostic factors.METHODSThe authors retrospectively analyzed the data for 8 patients with intracanalicular ONSMs who had been surgically treated by the senior author (O.A.) between 1998 and 2016. Meningiomas extending into the optic canal from the intracranial cavity (i.e., clinoid, sphenoid wing, tuberculum sellae, diaphragma sellae) were excluded. Diagnosis was based on ophthalmological, radiological, and intraoperative findings, which were confirmed by the typical histological findings. Preoperative, postoperative, and follow-up visual assessments were performed by neuro-ophthalmologists in all cases.RESULTSThe patients included 7 females and 1 male. The mean age at diagnosis was 45.1 years (range 25.0–70.0 years). Mean duration of follow-up was 38.9 months (range 3.0–88.0 months). All patients reported visual complaints, and all had objective evidence of optic nerve dysfunction. Their evaluation included visual field, visual acuity, funduscopy, and retinal fiber thickness. Total resection was obtained in 4 cases. Comparing preoperative and postoperative visual function revealed that 4 patients had improvement at the last follow-up, 1 patient had stable vision, and 3 patients had decreased function but none had total vision loss. All patients with good preoperative visual acuity maintained this status following surgical treatment. There was no surgical mortality or infection. Operative complications included binocular diplopia in 4 patients, which remitted spontaneously.CONCLUSIONSSurgery can play a beneficial role in the primary treatment of ONSM, especially lesions located in the posterior third of the nerve. Total removal can be achieved with vision preservation or improvement, without major surgical complications, especially at early stages of the disease. Patients with good preoperative vision and CSF flow in the optic sheath have better chances of a favorable outcome than those with poor vision.

Repeat Resection of a Cavernous Malformation of the Optic Nerve/Chiasm via a Frontotemporal Approach: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E169-E170 ◽  
Author(s):  
Yair M Gozal ◽  
Gmaan Alzhrani ◽  
Hussam Abou-Al-Shaar ◽  
William T Couldwell
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Vision Loss ◽  
Cavernous Malformation ◽  
Complete Resection ◽  
Vascular Lesions ◽  
Nerve Lesion ◽  
Cavernous Malformations ◽  
Visual Symptoms ◽  
Histopathologic Evaluation

Abstract Cavernous malformations are benign vascular lesions that can arise throughout the central nervous system. The occurrence of a cavernous malformation within the optic nerve or chiasm, however, is extremely uncommon. The case described in this video involved a 36-yr-old woman who presented 3 mo after undergoing a left frontotemporal craniotomy for resection of an optic nerve cavernous malformation. She had initially presented to an outside hospital with vision loss, and the left optic nerve lesion was identified and resected. Although her vision had reportedly improved slightly postoperatively, she awoke 3 mo later with bilateral subjective blurriness and new visual field deficits. Magnetic resonance imaging revealed enlargement of the left optic apparatus hemorrhagic lesion, corresponding to residual cavernous malformation. Given the recurrence of hemorrhage and the associated visual symptoms, the patient underwent a redo left frontotemporal craniotomy for resection of the optic nerve and chiasmal lesion. Histopathologic evaluation revealed thick-walled vessels with focal intervening glial tissue, an absence of neoplastic cells, and hemorrhage, consistent with a cavernous malformation. The patient tolerated the procedure well. Postoperatively, she experienced immediate amelioration in her visual symptoms. She was discharged home on postoperative day 3, and her bitemporal visual field deficit continued to progressively improve through her last ophthalmologic appointment 14 mo after surgery. Postoperative and subsequent surveillance neuroimaging demonstrated complete resection of the cavernous malformation without evidence of recurrence. This case demonstrates the techniques utilized to ensure complete resection of the malformation in this very eloquent region. The patient provided consent for publication.

Complete unilateral vision loss and optic nerve cupping from metastatic prostate cancer to the optic canal

2021 ◽  
Vol 14 (1) ◽  
pp. e236685
Author(s):  
Aaron T Chan ◽  
Jonathan A Micieli
Keyword(s):  
Prostate Cancer ◽  
Optic Nerve ◽  
Optic Disc ◽  
Vision Loss ◽  
The Body ◽  
Optic Canal ◽  
Neuroretinal Rim ◽  
Bone Expansion ◽  
Castrate Resistant ◽  
Optic Disc Cupping

A 71-year-old man, living with metastatic castrate-resistant prostate cancer to the lymph nodes, spine and skull, presented with acute on chronic left eye vision loss. Examination revealed no-light-perception vision, a relative afferent pupillary defect and optic disc cupping. MRI brain revealed optic canal narrowing from metastatic sphenoid bone expansion and extraosseous tumour compressing the intracanalicular optic nerve. The optic disc cupping and excavation without significant pallor of the remaining neuroretinal rim was likely secondary to chronic compression of the optic nerve. The patient was treated with radiation therapy, but did not regain vision and was referred to palliative care as his condition continued to worsen. As patients live longer with advanced cancer, there is a greater risk of metastasis to atypical areas of the body including the optic nerve. This case demonstrates the unique combination of optic disc cupping from optic canal metastasis due to prostate cancer.

Management of Optic Neuritis in Ayurveda - A Special Case Report

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Harsha S. ◽  
Dr. Mamatha KV.
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Visual Information ◽  
Vision Loss ◽  
Specific Treatment ◽  
Interesting Case ◽  
Treatment Modalities ◽  
Further Development ◽  
Special Case

The optic nerve carries visual information from your eye to your brain. Optic neuritis is when your optic nerve becomes inflamed. Optic neuritis can flare up suddenly from an infection or nerve disease. The inflammation usually causes temporary vision loss that typically happens in only one eye. Those with Optic neuritis sometimes experience pain. As you recover and the inflammation goes away, your vision will likely return. There are no direct references in our classics regarding optic neuritis but can be contemplated as a condition by name Parimlayi Timira. The specific management as such is not cited but a transcendence approach can be done with adopting the treatment which has the ability to pacify the already occurred pathology and prevent the further development of the disease. One such interesting case study on Optic neuritis is elaborated here where in specific treatment modalities (Shodana, Shamana and Kriyakalpas) played role in pacifying the condition.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

scholarly journals Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
K. El-Bahy ◽  
Ashraf M. Ibrahim ◽  
Ibrahim Abdelmohsen ◽  
Hatem A. Sabry
Keyword(s):  
Cavernous Sinus ◽  
Tumor Resection ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Cavernous Sinus Invasion ◽  
Anterior Clinoidectomy ◽  
Microsurgical Techniques

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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