scholarly journals Resection of a Petroclival Meningioma via the Endoscope-Assisted Retrosigmoid Approach: 2-D Operative Video

2018 ◽  
Vol 79 (S 05) ◽  
pp. S395-S396
Author(s):  
Stefan Lieber ◽  
Rocio Evangelista-Zamora ◽  
Florian Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Facial Palsy ◽  
Operative Technique ◽  
Retrosigmoid Approach ◽  
Total Resection ◽  
Vestibulocochlear Nerve ◽  
Petroclival Meningioma ◽  
Skull Base Approach ◽  
Endoscopic Assistance ◽  
Neurovascular Structures

AbstractWe present a case of a petroclival meningioma that was resected through an endoscope-assisted retrosigmoid approach via corridors above and below the facial-vestibulocochlear nerve complex. The patient is a 61-year-old female with complaints of left-sided hypesthesia and neuralgia of the infraorbital and zygomatic region, intermittent periorbital myokymia, and a slight facial palsy (HB II). This 2D video demonstrates the operative technique, anatomical and surgical nuances of the skull base approach and microdissection of the tumor from the critical neurovascular structures. A gross total resection was achieved. The patient’s facial and trigeminal symptoms resolved completely within a few weeks. At 2 year follow up there was no indication of residual or recurrence.In summary, the retrosigmoid approach with endoscopic assistance is an important and powerful tool in the armamentarium for the microsurgical management of meningiomas of the lateroventral skullbase of the posterior fossa.The link to the video can be found at: https://youtu.be/Px4XIRDoALc.

Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS202-ONS211 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
U. Kumar Kakarla ◽  
Louis J. Kim ◽  
Peter Nakaji ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Survival Rates ◽  
Progression Free Survival ◽  
Surgical Approaches ◽  
Single Institution ◽  
Short Term ◽  
Total Resection ◽  
Free Survival ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas

Abstract Objective: We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time. Methods: Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression. Conclusion: Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

Retrosigmoid approach for resection of petroclival meningioma

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Anil Nanda ◽  
Sudheer Ambekar
Keyword(s):  
Cranial Nerves ◽  
Retrosigmoid Approach ◽  
Bone Flap ◽  
Petroclival Meningioma ◽  
Link Type ◽  
Key Steps ◽  
Lower Cranial Nerves ◽  
Neurovascular Structures

This video describes the classic retrosigmoid approach for the resection of petroclival lesions. In this procedure, a careful dissection of the tumor within the arachnoid plane from the neurovascular structures is described. The key steps in the procedure are outlined, and include positioning, tumor devascularization, decompression, dissection from lower cranial nerves, IV, V cranial nerves and the VII-VIII complex and from the brainstem and closure of the dura, bone flap and the incision.The video can be found here: http://youtu.be/DmutL7dBOxI.

scholarly journals Retrosigmoid Transmeatal Endoscope-Assisted Approach in Semi-Sitting Position for Resection of Vestibular Schwannoma: 2-D operative Video

2018 ◽  
Vol 79 (S 05) ◽  
pp. S385-S386
Author(s):  
Rocio Evangelista-Zamora ◽  
Stefan Lieber ◽  
Florian Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Sitting Position ◽  
Speech Discrimination ◽  
Endoscopic Assistance ◽  
Set Up ◽  
One Year ◽  
The Right ◽  
Neurovascular Structures

We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting position under endoscopic assistance. The patient is a 52-year-old male with acute loss of functional hearing on the right side. Audiometry confirmed a loss of up to 60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical nuances of the skull base approach and the operative technique for microdissection of the tumor from the critical neurovascular structures, especially the facial and cochlear nerves. A gross total resection was achieved and the patient discharged home after four days with unaltered function of the facial nerve (HB I). At one year follow up there was no indication of residual or recurrence.In summary, the retrosigmoid transmeatal approach is an important and powerful tool in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semi-sitting position is safe and effective. If needed, the approach can be complemented by the use of an endoscope for visualization of the distal internal auditory canal.The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.

scholarly journals Combined Frontotemporal Transbasal Approach for the Resection of a Giant Rathke's Cleft Cyst: Operative Video and Technical Nuances

2018 ◽  
Vol 79 (S 03) ◽  
pp. S276-S277
Author(s):  
James Liu
Keyword(s):  
Rathke’S Cleft Cyst ◽  
Lateral Extension ◽  
Rathke's Cleft Cyst ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Skull Base Approach ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Neurologically Intact ◽  
Neurovascular Structures

AbstractWe present a case of a giant Rathke's cleft cyst with significant superior extension into the third and right lateral ventricles and lateral extension into the left Sylvian fissure and over the anterior clinoid process. An extended modification of the frontotemporal approach was performed using a combined frontotemporal transbasal approach. This allowed wide exposure to both transsylvian and subfrontal corridors to the retrochiasmatic space. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, microdissection of the tumor, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient was neurologically intact with improved visual acuity. In summary, the combined frontotemporal transbasal approach is an important strategy in the armamentarium for the surgical management of giant Rathke's cleft cysts.The link to the video can be found at: https://youtu.be/UjhnUZVi03I.

scholarly journals Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

2017 ◽  
Vol 79 (02) ◽  
pp. 167-172 ◽  
Author(s):  
Ahmed Farhoud ◽  
Wael Khedr ◽  
Hisham Aboul-Enein
Keyword(s):  
Cranial Nerves ◽  
Postoperative Mortality ◽  
Residual Tumor ◽  
Retrosigmoid Approach ◽  
Subtotal Resection ◽  
Total Resection ◽  
Surgical Strategies ◽  
Epidermoid Cysts ◽  
Presenting Symptoms

Objective Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions. Material and Methods The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year. Results There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them. Conclusion The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

Fully Endoscopic Resection of an Epidermoid Cyst of the Cerebellopontine Angle: Bilateral Resection via a Unilateral Approach

2020 ◽  
Author(s):  
Sricharan Gopakumar ◽  
Visish M Srinivasan ◽  
Himanshu Sharma ◽  
Jacob Cherian ◽  
Akash J Patel
Keyword(s):  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Clinical Presentation ◽  
Contralateral Side ◽  
Radiographic Imaging ◽  
Total Resection ◽  
Surgical Video ◽  
Unilateral Approach ◽  
Neurovascular Structures

ABSTRACT BACKGROUND AND IMPORTANCE Epidermoid cysts are rare, benign intracranial neoplasms that typically arise at the cerebellopontine angle (CPA) and can be extensive lesions that intricately involve many critical neurovascular structures. We describe the case of a patient who presents with the classic picture of CPA epidermoid cyst and describe the value of the 4K endoscope for resection, which is illustrated in our accompanying surgical video. CLINICAL PRESENTATION The patient presents with headache, nausea, and vomiting accompanied by dizziness and balance issues. Radiographic imaging demonstrated a large lesion highly consistent with epidermoid cyst which involved the left CPA, encircled the basilar artery, and extended to the opposite side. Surgery was planned with a small left-sided retrosigmoid craniotomy with use of a 2-dimensional 4K endoscope to aid in resection, particularly of the contralateral side. This approach was successful with gross total resection apparent at 14-mo follow-up. CONCLUSION We describe the use of a fully endoscopic technique from a unilateral approach for resection of a lesion that extended in the CPA bilaterally. Additionally, we highlight the relevant neuroanatomical and neurovascular structures in this highly critical intracranial region which is well-visualized through endoscopy in the associated surgical video.

scholarly journals Extended Retrosigmoid Approach for Cerebellopontine Angle Meningiomas: Operative Technique and Results—A Series of 28 Patients

2018 ◽  
Vol 79 (05) ◽  
pp. 458-465 ◽  
Author(s):  
Celestino Pereira ◽  
Leonardo Welling ◽  
Mariangela Gonçalves ◽  
Nelci Zanon ◽  
Jose Lynch
Keyword(s):  
Operative Technique ◽  
Cerebellopontine Angle ◽  
Cranial Base ◽  
Sigmoid Sinus ◽  
Retrosigmoid Approach ◽  
Surgical Mortality ◽  
Total Removal ◽  
Surgical Strategies ◽  
The Mean

Background The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). Methods We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. Results The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). Conclusion The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cranial base approaches.

scholarly journals Petroclival Meningiomas: Factors Determining the Choice of Approach

2017 ◽  
Vol 79 (04) ◽  
pp. 367-378 ◽  
Author(s):  
Gustavo Isolan ◽  
Sâmia Wayhs ◽  
Guilherme Lepski ◽  
Leandro Dini ◽  
Joel Lavinsky
Keyword(s):  
Tumor Progression ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Retrosigmoid Approach ◽  
University Hospital ◽  
Gross Total Resection ◽  
Middle Fossa ◽  
Total Resection ◽  
Petroclival Meningiomas

Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Design Retrospective review. Setting The study was conducted in a university hospital in southern Brazil. Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6–75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.

scholarly journals Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Arthur Wagner ◽  
Ann-Kathrin Joerger ◽  
Nicole Lange ◽  
Bernhard Meyer ◽  
Ehab Shiban
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Close Association ◽  
Consecutive Series ◽  
Imaging Data ◽  
Single Institution ◽  
Vestibulocochlear Nerve ◽  
Microsurgical Resection ◽  
Neurovascular Structures

Abstract Tentorial meningiomas (TMs) may challenge the surgeon with their close association to neurovascular structures. We analyzed a consecutive series with regard to surgical and functional outcome following microsurgical resection. We retrospectively reviewed patient charts and imaging data of every patient with a TM resected at a single institution and compared surgical and functional outcomes between groups stratified by choice of approach. 57 consecutive patients from October 2006 to September 2017 were included, of which 75.4% were female; mean age was 60 years (range 31–90), follow-up data was available for 85.4% and reached a mean of 18.3 (range 2–119) months with a median of 14.5 months. 54.4% of TMs were located at the medial compartments of the tentorium, 45.6% at the lateral edges. Complete resection defined as Simpson grades I and II was achieved in 72% of all cases, without statistically significant differences for both subgroups (p = 0.532). 9 patients (15.8%) developed a new cranial nerve palsy postoperatively with the vestibulocochlear nerve affected exclusively in the lateral subgroup (8.8% of total), followed by disturbances of oculomotion (5.4%). After 12 months, 93.0% of patients with available follow-up after 12 months retained fully independent functional status without deficit. Despite providing a surgical challenge due to potentially complicated anatomical relations, the choice of an appropriate surgical strategy overall results in favourable oncological and functional outcome after resection of TMs.

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