Resection of a Dumbbell Skull Base Meningioma by a Combined Two-Staged Retrosigmoid and Transzygomatic Transcavernous Approach

This case describes a 32-year-old male with 2 months of headache accompanied with slight right-hand hemiparesis. During a physical examination, he was also detected left facial hypoesthesia. An enhanced magnetic resonance imaging (MRI) showed a large size lesion on the region of the left cerebellopontine angle, with large displacement of the brainstem and cerebellum. The tumor extended to the cavum of Meckel, displacing and pushing the left cavernous sinus upward. After analyzing the anatomical characteristics of the tumor, surgery was decided in two steps. Since the symptoms were mostly produced by the tumor part located in the posterior fossa, a decision was made to first resect that part of the tumor. With the patient in a semisitting position, we performed a left retrosigmoid craniotomy, exposing the transverse and sigmoid sinus edges. Using microsurgical technique, and ultrasonic aspirator, the complete removal of the lesion located in the posterior fossa was achieved. The patient presented a very good postoperative period, without a new neurological deficit. A month after the surgery, the patient no longer suffered from headaches or hemiparesis, but continued the left facial hypoesthesia. The pathology reported clear cell meningioma. Another month later, a transcygomatic approach plus peeling of the cavernous sinus was performed with the patient in the supine position and head rotated to the right side. Spinal drainage was previously placed. The total resection of the tumor was achieved without any surgical complication. The patient presented an excellent postoperative condition without new neurological deficit. The pathologist confirmed the diagnosis of clear cell meningioma.The link to the Video can be found at: https://youtu.be/SmRy5HiJYJI.

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Nondural-based lumbar clear cell meningioma

Journal of Neurosurgery ◽

10.3171/jns.1996.84.2.0264 ◽

1996 ◽

Vol 84 (2) ◽

pp. 264-266 ◽

Cited By ~ 29

Author(s):

Robert N. N. Holtzman ◽

Susan C. Jormark

Keyword(s):

Clear Cell ◽

Cauda Equina ◽

Complete Removal ◽

Leg Pain ◽

Content Type ◽

Single Root ◽

Clear Cell Meningioma ◽

Extensor Hallucis Longus ◽

The Right ◽

Immunohistochemical Analyses

✓ This 32-year-old man had noticed right leg pain for 4 years and developed classic right sciatica after heavy lifting, followed by episodes of buckling of both legs 1 month prior to admission. His medical history included congenital left abducens palsy. Examination revealed a right Lasègue's sign and Fajersztajn's sign with mild weakness of the right extensor hallucis longus. Magnetic resonance imaging revealed a 1.5 × 2.0—cm enhancing intradural lesion at the L3–4 level. Following laminectomy of L-3 and L-4 and intradural exposure, the tumor was found to be draped loosely by the roots of the cauda equina and attached to a single root without any adherence to dura. Transection of the adherent fascicles and typical microdissection of arachnoidal filaments permitted its complete removal without violation of the capsule, allowing the preservation of a large fascicle. The patient's recovery was uneventful. Postoperatively, a mild right lateral foot hypalgesia and diminution of the right ankle jerk implicated the S-1 root. Histological and immunohistochemical analyses diagnosed the specimen as a clear cell meningioma.

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Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727147 ◽

2021 ◽

Author(s):

Yoichi Nonaka ◽

Naokazu Hayashi ◽

Takanori Fukushima

Keyword(s):

Carotid Artery ◽

Skull Base ◽

Posterior Fossa ◽

Cavernous Sinus ◽

Middle Fossa ◽

Total Resection ◽

Middle Fossa Approach ◽

Cavernous Sinus Meningioma ◽

Skull Base Meningioma ◽

The Right

Abstract Objective The aim of this study is to describe surgical management of invasive cavernous sinus meningioma with a combination of skull base approaches. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. In this video, we describe our experience with the successful treatment of a recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 53-year-old male presented with a 1-year history of progressing right-side complete oculomotor palsy and facial dysesthesia. The patient had previously undergone craniotomy for the right-side petroclival cavernous meningioma (Fig. 1A and B). Total 8 years after the first surgery, the remaining portion of the cavernous sinus grew up and extended into the posterior fossa (Fig. 1C). Then the second surgery was performed to resect only the posterior fossa component (Fig. 1D). However, the follow-up magnetic resonance imaging revealed an aggressive tumor regrowth in 2 years. The tumor occupied the right middle fossa with an extension to the posterior fossa and infratemporal fossa (Fig. 1E and F). We scheduled to perform gross total resection of the tumor through a combined transzygomatic transcavernous and extended middle fossa approach with preparation for vessel reconstruction. Mild adhesion between the tumor and the cavernous carotid artery facilitated complete resection of the intracavernous component of the tumor (Fig. 2A–C). Conclusion A combination of skull base approaches provides multidirectional operative corridors and wide exposure of the skull base lesions.The link to the video can be found at https://youtu.be/DB_WXFeyBvo.

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Posterior fossa clear cell meningioma without dural attachment in a child

Child s Nervous System ◽

10.1007/s00381-008-0757-7 ◽

2008 ◽

Vol 25 (3) ◽

pp. 389-392 ◽

Cited By ~ 16

Author(s):

Pablo Miranda ◽

Juan Antonio Simal ◽

Manuel Vila ◽

Miguel Hernández ◽

Francisco Menor ◽

...

Keyword(s):

Posterior Fossa ◽

Clear Cell ◽

Clear Cell Meningioma ◽

Dural Attachment

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Multiple Colloid Cysts: Case Report and Literature Review

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1641145 ◽

2018 ◽

Vol 79 (06) ◽

pp. 536-540

Author(s):

Martin Bettag ◽

Ahmed Rizk

Keyword(s):

Lateral Ventricle ◽

Third Ventricle ◽

Complete Removal ◽

Ventricular Catheter ◽

Foramen Of Monro ◽

The Third ◽

Colloid Cysts ◽

Magnetic Resonance Imaging Mri ◽

Clinical Description ◽

The Right

Background and Study Aim Colloid cysts usually occur in the anterior third ventricle at the level of the foramina of Monro. Colloid cysts may extend from the third toward the lateral ventricle. We present a rare case of multiple intraventricular colloid cysts, two of which were in the third ventricle and one in the lateral ventricle. Clinical Description A 40-year-old female patient presented with three intraventricular cystic lesions: one cyst in the typical localization in the anterior rostral third ventricle, another cyst behind it in the same (third) ventricle, and a larger bulging cyst in the right lateral ventricle. A bilateral ventriculoperitoneal shunt had been inserted 26 years before to treat hydrocephalus. All three cysts had different magnetic resonance imaging (MRI) signal characteristics. We removed the cysts through an endoscopically assisted right transcortical transventricular microsurgical approach, using the right ventricular catheter as a guide to the lateral ventricle. After removal of the lateral ventricular cyst, we observed that the foramen of Monro was greatly enlarged (most likely as a result of the large cyst), which allowed us to remove the cysts in the third ventricle. During surgery, the cysts were found to have different consistencies. MRI 2 years following surgery showed complete removal and no hydrocephalus. The patient had no symptoms, and the clinical examinations were normal. Conclusions Colloid cysts may become large and extend to the lateral ventricle, especially in patients treated with ventriculoperitoneal shunts. Studying the relevant pathoanatomy of these cysts is very important for preoperative planning including the choice of surgical approach.

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Neuroimaging of Children With Takayasu Arteritis

Journal of Child Neurology ◽

10.1177/0883073821991287 ◽

2021 ◽

pp. 088307382199128

Author(s):

Hafize Emine Sönmez ◽

Ferhat Demir ◽

Semanur Özdel ◽

Şerife Gül Karadağ ◽

Esra Bağlan ◽

...

Keyword(s):

Takayasu Arteritis ◽

Internal Carotid ◽

Laboratory Data ◽

Left Middle Cerebral Artery ◽

Mri Findings ◽

Cranial Mri ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

And Diffusion ◽

Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

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Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography

Healthcare ◽

10.3390/healthcare9010094 ◽

2021 ◽

Vol 9 (1) ◽

pp. 94

Author(s):

Sun Ah Heo ◽

Eun Soo Kim ◽

Yul Lee ◽

Sang Min Lee ◽

Kwanseop Lee ◽

...

Keyword(s):

Cavernous Sinus ◽

Signal Intensity ◽

Time Of Flight ◽

Weighted Kappa ◽

Wilcoxon Test ◽

Tof Mra ◽

Superior Petrosal Sinus ◽

Grade Difference ◽

Diagnostic Modalities ◽

The Right

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: −0.12–0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

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Granulomatous orchitis: case report and review of the literature

Journal of International Medical Research ◽

10.1177/03000605211003773 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110037

Author(s):

Liu Liang ◽

Wang Jiajia ◽

Li Shoubin ◽

Qi Yufeng ◽

Wang Gang ◽

...

Keyword(s):

Color Doppler ◽

Radical Resection ◽

Blood Flow Imaging ◽

Low Intensity ◽

Disease Characteristics ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Combined Spinal Epidural Anesthesia ◽

Spinal Epidural

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.

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An unusual case of clear cell meningioma

Journal of Cancer Research and Therapeutics ◽

10.4103/0973-1482.59902 ◽

2009 ◽

Vol 5 (4) ◽

pp. 324 ◽

Cited By ~ 2

Author(s):

Prabal Deb ◽

SubramanyaG.S Datta

Keyword(s):

Unusual Case ◽

Clear Cell ◽

Clear Cell Meningioma

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Primary Occipital Ewing’s Sarcoma with Subsequent Spinal Seeding

Case Reports in Pediatrics ◽

10.1155/2017/1521407 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ali Alqahtani ◽

Roaa Amer ◽

Eman Bakhsh

Keyword(s):

Posterior Fossa ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Bone Cancer ◽

Surgical Excision ◽

Good Prognosis ◽

Bone Lesions ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Whole Spine

Ewing’s sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing’s sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing’s sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing’s sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing’s sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.

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