scholarly journals Microsurgical Gross Total Resection of a WHO Grade II Cerebellopontine Angle Ependymoma in an Adult

2018 ◽  
Vol 79 (S 05) ◽  
pp. S426-S427
Author(s):  
Sima Sayyahmelli ◽  
Melih Ucer ◽  
Mustafa Baskaya
Keyword(s):  
Cerebellopontine Angle ◽  
Residual Disease ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Choroid Plexus Papilloma ◽  
Gross Total Resection ◽  
Direct Stimulation ◽  
Total Resection ◽  
Who Grade ◽  
Grade Ii

Infratentorial ependymomas that arise in the fourth ventricle and extend into the cerebellopontine angle (CPA) through the foramina of Luschka are well described. However, a primary CPA location of an ependymoma is distinctly uncommon. In this video, we present a 46-year-old man with episodes of dizziness, left-sided tinnitus, imbalance, double vision, and nausea. An magnetic resonance imaging (MRI) scan of the head showed a large mass lesion centered in the CPA with heterogenous enhancement. Differential diagnosis included ependymoma, meningioma, schwannoma of the vestibular nerve, or lower cranial nerves, and choroid plexus papilloma. He underwent microsurgical gross total resection of the tumor via a retrosigmoid approach. Direct stimulation of the cranial nerves was performed throughout the case and there was no attachment of the tumor to any cranial nerve to suggest that this might be a schwannoma. The tumor encased important vasculature, including the posterior-inferior cerebellar artery. The histopathology was a grade II ependymoma. The patient tolerated the surgery well and his postoperative course was uneventful. He remained neurologically intact. He received radiation therapy and there was no recurrent or residual disease on follow-up studies. This video demonstrates important steps of the surgical approach and microsurgical resection techniques for this type of challenging tumor.The link to the video can be found at: https://youtu.be/KK-y6EYh888.

scholarly journals Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burak Ozaydin ◽  
G. Mark Pyle ◽  
Mustafa K. Baskaya
Keyword(s):  
Cavernous Sinus ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
World Health ◽  
Gross Total Resection ◽  
Surgical Removal ◽  
Total Resection ◽  
Meckel’S Cave ◽  
Who Grade ◽  
Meckel's Cave

AbstractMicrosurgery of cavernous sinus (CS) lesions is generally considered to be associated with a high rate of morbidity and cranial nerve deficits. The success for surgical removal of CS meningiomas is debatable and achieving a good functional outcome with preservation of the cranial nerves is the goal. Surgery of these lesions is challenging, recurrence rates are high, and therapeutic strategies remain controversial. In this video, we present a case of a CS meningioma that extended to Meckel's cave and the posterior fossa in a 46-year-old woman with history of a left-sided cerebellopontine angle World Health Organization (WHO) grade-I meningioma with extension to the left CS. Seven years ago, she had a microsurgical resection of a Cerebellopontine angle (CPA) meningioma. She later received radiotherapy for the slowly growing meningioma of the posterior CS. The patient presented with newly onset headache and facial pain. Magnetic resonance imaging (MRI) showed a meningioma of the left CS and Meckel's cave extending into the ambient cistern, with a mild mass effect on the pons, and a size increase compared with prior imaging. Since this area previously received radiotherapy, and the patient was symptomatic from trigeminal compression, the decision was made to proceed with surgical resection of the tumor via combined transcavernous and anterior petrosectomy. Postoperatively, the patient woke up with the same neurological status. MRI confirmed gross total resection of the tumor. The histopathology was a WHO grade-II chordoid meningioma. The patient is currently receiving radiotherapy. This video demonstrates the surgical approach and the resection steps of this pathology.The link to the video can be found at: https://youtu.be/HrU1VOzUGWU.

scholarly journals Retrosigmoid Approach for Resecting a Giant Lateral Pontine Ependymoma: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Hongxiang Wang ◽  
Yong Yan ◽  
Tao Xu ◽  
Juxiang Chen
Keyword(s):  
Brain Stem ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Ependymal Cells ◽  
Total Resection ◽  
Petrosal Vein ◽  
Cerebellar Artery

AbstractEpendymoma is one of the most common pediatric tumors in central nervous system, for which gross total resection has been the most favorable prognostic factor.1 2 However, surgery of ependymomas located in brain stem is significantly challenging. This video demonstrates the microsurgical removal of an ependymoma originating from ependymal cells of the lateral recess of fourth ventricle via retrosigmoid approach in an 11-year-old female. The patient presented with a 6-month history of continues headache and vomiting. On examination, she had a walking instability and an emaciated body. Neuroimaging revealed a right lateral pontine lesion extending to the cerebellopontine angle region. The patient underwent a suboccipital craniotomy, followed by excellent exposure for the tumor. Petrosal vein encased by the tumor mass and close adhesion of the tumor and the initial segments of facial and acoustic nerves adjoined brain stem could be seen operatively. While preserving trigeminal nerve, facial and acoustic nerves, posterior cranial nerves, anterior inferior cerebellar artery, labyrinth artery, posterior inferior cerebellar artery, and petrosal vein, gross total resection was achieved under the careful operation along arachnoid spaces together with intratumoral decompression. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as an ependymoma (WHO II). The cytology measurement of the cerebrospinal fluid did not find any tumor cells. Postoperative computed tomography and magnetic resonance imaging scan depicted complete resection of the tumor, and adjuvant radiotherapy was recommended. She remained symptom-free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.The link to the video can be found at: https://youtu.be/sZ9GhUeltwc.

scholarly journals Diagnosis and Predictors of Treatment Outcomes in Meningiomas with Atypical or Anaplastic Histology

2018 ◽  
Vol 27 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Gustavo Simiano Jung ◽  
Ricardo Ramina ◽  
Erasmo Barros Da Silva Jr ◽  
Maurício Coelho Neto
Keyword(s):  
Treatment Outcomes ◽  
Treatment Options ◽  
Gross Total Resection ◽  
Total Resection ◽  
Who Grade ◽  
Grade Ii ◽  
Anaplastic Histology ◽  
Biological Nature

Atypical and anaplastic meningiomas (WHO grade II and III) are uncommon tumors with poorer prognosis than benign meningiomas. They represent a small and heterogeneous subgroup of meningiomas that has more aggressive biological nature and higher frequency of recurrence. Treatment of these tumors remains challenging and recurrence is common even after gross total resection. We report five year experience of an experienced neurosurgical center (INC) reviewing treatment options and predictor of treatment outcomes for malignant meningiomas.

scholarly journals Endoscopic Assisted Retrosigmoid Approach for Cerebellopontine Angle Epidermoid Tumor

2018 ◽  
Vol 79 (S 05) ◽  
pp. S413-S414
Author(s):  
Katherine Kunigelis ◽  
Alexander Yang ◽  
A. Youssef
Keyword(s):  
Cerebellopontine Angle ◽  
Antiviral Agents ◽  
Cranial Nerves ◽  
Pineal Region ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Total Resection ◽  
Auditory Evoked Responses ◽  
The Right ◽  
Surgical Corridor

This case is a 20-year-old male, who presented with 1 month of right facial weakness (HB4) and complaints of ipsilateral eye dryness. He was initially treated for Bell's palsy with steroids and antiviral agents, but subsequently developed diplopia with right lateral gaze and underwent an MRI (magnetic resonance imaging). MRI demonstrated a 4.5 cm irregular lesion in the right cerebellopontine angle consistent with an epidermoid cyst. Because the tumor had grown with the development of the central nervous system, it has extended into different compartments, including the tentorial incisura and pineal region. A predefined surgical corridor created by the tumor facilitated access to the majority of the tumor through a retrosigmoid approach. Angled endoscopes (30-degree up and down) provided further visualization of tumor away from the line of sight of the microscope, thus allowing for gross total resection of the lesion. This video also demonstrates a sharp dissection technique necessary for safe removal of adherent tumor from critical neurovascular structures, including the basilar artery and several cranial nerves. The ipsilateral auditory evoked responses (ABRs) showed slight improvement from baseline toward the end of the case. A gross total resection was achieved, as shown by the MRI. The patient remained at his baseline cranial nerve (CN) V, VII, and VIII deficits during the immediate postoperative period.The link to the video can be found at: https://youtu.be/vCq5juJh8hk.

Letter to the Editor Regarding “Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection”

2020 ◽  
Vol 142 ◽  
pp. 537
Author(s):  
Gustavo Correa Lordelo ◽  
Victor Salviato Nespoli ◽  
Iuri Santana Neville ◽  
Wellingson Silva Paiva
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Letter To The Editor ◽  
Grade Ii

scholarly journals Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burcak Soylemez ◽  
Sima Sayyahmelli ◽  
Nese Keser ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Left Internal Carotid Artery ◽  
Total Resection ◽  
Complete Occlusion ◽  
Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

scholarly journals Gross Total Resection of Large Cerebellopontine Angle Meningioma with a Supratentorial Extension via Retrosigmoid Approach with Suprameatal Drilling and Tentorial Sectioning

2018 ◽  
Vol 79 (S 05) ◽  
pp. S399-S401
Author(s):  
Sima Sayyahmelli ◽  
Adi Ahmetspahic ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Cerebellopontine Angle ◽  
Surgical Techniques ◽  
Retrosigmoid Approach ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Facial Numbness ◽  
Magnetic Resonance Imaging Mri ◽  
Health Organization

Meningiomas are the second most common neoplasm in the cerebellopontine angle (CPA), and are challenging lesions to treat surgically. With significant refinements in surgical techniques, operative morbidity, and mortality have been substantially reduced. Total or near-total surgical resection can be accomplished in the majority of cases via appropriately selected approaches, and with acceptable morbidity. In this video, we present a 51-year-old woman, who had a 2-year history of vertigo with symptoms that progressed over time. She presented with blurry vision, sensorineural hearing loss, tinnitus, left-sided facial numbness, and double vision. Magnetic resonance imaging (MRI) showed a left-sided homogeneously enhancing mass at CPA with a supratentorial extension. MRI appearance was consistent with a CPA meningioma with supratentorial extension. The patient underwent surgical resection via a retrosigmoid approach. Suprameatal drilling and tentorial sectioning were necessary to achieve gross total resection. The surgery and postoperative course were uneventful. The histopathology was a WHO (world health organization) grade I meningioma. MRI showed gross total resection of the tumor. After a 1.5-year follow-up, the patient is continuing to do well with no residual or recurrent disease. In this video, microsurgical techniques and important steps for the resection of this challenging meningioma of the cerebellopontine angle are demonstrated.The link to the video can be found at: https://youtu.be/CDto52GxrG4.

Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma

2017 ◽  
Vol 103 ◽  
pp. 655-663 ◽  
Author(s):  
Christopher S. Graffeo ◽  
Heather E. Leeper ◽  
Avital Perry ◽  
Joon H. Uhm ◽  
Daniel J. Lachance ◽  
...  
Keyword(s):  
World Health Organization ◽  
Adjuvant Radiotherapy ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Grade Ii ◽  
Health Organization

Modified Transpetrosal–Transtentorial Approach for Resection of Large and Giant Petroclival Meningioma: Technical Nuance and Surgical Experiences

2021 ◽  
Author(s):  
Irwan Barlian Immadoel Haq ◽  
Joni Wahyuhadi ◽  
Akhmad Suryonurafif ◽  
Muhammad Reza Arifianto ◽  
Rahadian Indarto Susilo ◽  
...  
Keyword(s):  
Maximum Diameter ◽  
Total Resection ◽  
Who Grade ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Superior Petrosal Sinus ◽  
Grade Ii ◽  
A New Technique ◽  
Average Tumor Size ◽  
Transtentorial Approach

Abstract Background Meningiomas arising from the petroclival area remain a challenge for neurosurgeons. Various approaches have been proposed to achieve maximum resection with minimal morbidity and mortality. Also, some articles correlated preservation of adjacent veins with less neurologic deficits. Objective To describe the experiences in using a new technique to achieve maximal resection of petroclival meningiomas and preserving the superior petrosal veins (SPVs) and the superior petrosal sinus (SPS). Methods A retrospective analysis of 26 patients harboring a true petroclival meningioma with a diameter ≥25 mm and undergoing surgery with the modified transpetrosal–transtentorial approach (MTTA) was performed. Results Fifty-four percent of 22 patients complained of severe headache at presentation. There was also complaint of cranial nerve (CN) deficit, with CN VII deficit being the most common (present in 42% of patients). The average tumor size (measured as maximum diameter) was 45.2 mm, and most of the tumors compressed the brainstem. Total resection was achieved in 12 patients (46.2%), whereas the others were excised subtotally (54.8%). Most of the patients had WHO grade I (96.1%) meningioma; only one had a grade II (3.8%) meningioma. In addition, clinical improvement and persistence of symptoms were observed in 17 (65.4%) and 8 (30.7%) patients, respectively, and postoperative permanent CN injury was observed in 3 (11.5%) patients. Conclusion Using the MTTA, maximal resection with preservation of the CNs and neurovascular SPV-SPS complex can be achieved. Therefore, further studies and improvements of the technique are required to increase the total resection rate without neglecting the complications that may develop postoperatively.

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