Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas

2020 ◽  
Vol 81 (04) ◽  
pp. 355-361
Author(s):  
Tomu Okada ◽  
Kousuke Miyahara ◽  
Shin Tanino ◽  
Kouji Suzuki ◽  
Nobuyuki Watanabe ◽  
...  
Keyword(s):  
Radical Resection ◽  
Blind Spot ◽  
Pineal Region ◽  
Anterolateral Approach ◽  
Vein Of Galen ◽  
Operating Field ◽  
Sagittal Sinus ◽  
Window Method ◽  
A Site ◽  
Turn Over

Abstract Objective Falcotentorial meningioma occurs close to the falcotentorial edges and the confluence of the vein of Galen. The posterosuperior approach conventionally used to reach this site does not allow direct visualization of the tumor matrix, making detachment difficult. Meningiomas at this location are therefore among those that are not well amenable to radical resection. We devised an alternative anterolateral approach that, when used in addition to the posterosuperior approach, provides an operating field which allows to overview large, bilaterally extending tumors. We report this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach, together with associated procedural modifications. Methods We used the approach in four patients with falcotentorial meningioma between February 2008 and July 2017. We began by extending a parieto-occipital craniotomy slightly beyond the midline, to pass across the most caudal bridging vein on the rostral side. We then created a fan-shaped fenestration as large as possible in the falx, between the superior sagittal sinus and the inferior sagittal and straight sinuses (window 1). We further performed wedge-shaped resections of both tentorial edges to the left and right of window 1 (windows 2 and 3). Tumor debulking was then carried out via these three windows (the triple-window method). Finally, we detached the tumor in the area of the falcotentorial edges and the confluence of the vein of Galen. To obtain a superorostral operating field as wide as possible from laterally, thereby exposing the potential blind spots, the operating surgeon used both hands while retracting the precuneus, and the assistant surgeon used both hands to turn over the falcotentorial edges (twosome four-hand retractorless microsurgery). Results The wide operating field provided by this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach and twosome four-hand retractorless microsurgery provides a direct view of delicate structures at the falcotentorial edges and the confluence of the vein of Galen, a site that is most likely to be a blind spot in conventional approaches. Retraction of the precuneus on the nondominant side enabled radical resection with no neurologic deficit in any of the patients. Conclusions The parieto-occipital interhemispheric transfalcine, trans-bitentorial approach with the triple-window method opens an anterolateral operating field in addition to a posterosuperior operating field in large tumors located in the falcotentorial and pineal region, extending anteroposteriorly and bilaterally. The twosome four-hand retractorless technique via this approach enables visualization of the tumor matrix at sites, which are barely visible with the conventional approach. Thus, the tumor can be removed more radically and safely.

DEPICTION OF SMALL VEINS DRAINING INTO THE VEIN OF GALEN USING PREOPERATIVE 3‐DIMENSIONAL NAVIGATION IN LIVING PATIENTS

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons247-ons252 ◽  
Author(s):  
Mario Giordano ◽  
Karsten H. Wrede ◽  
Lennart H. Stieglitz ◽  
Laura Columbano ◽  
Madjid Samii ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Digital Subtraction Angiography ◽  
Pineal Region ◽  
Digital Subtraction ◽  
Vein Of Galen ◽  
Resonance Imaging ◽  
3 Dimensional ◽  
Small Vessels ◽  
Computed Tomographic

Abstract OBJECTIVE The purpose of this study was to delineate the anatomy of the precentral cerebellar vein, superior vermian vein, and internal occipital vein using reconstructions of computed tomographic and magnetic resonance imaging scans with navigation software. These data were compared with previous anatomic and angiographic findings to show the resolution and accuracy of the system. METHODS We retrospectively reviewed 100 patients with intracranial pathologies (50 computed tomographic scans with contrast and 50 magnetic resonance imaging scans with gadolinium) using a neuronavigation workstation for 3-dimensional reconstruction. Particular attention was paid to depiction of the precentral cerebellar vein, superior vermian vein, and internal occipital vein. The data were reviewed and analyzed. RESULTS The precentral cerebellar vein, superior vermian vein, and its tributary, the supraculminate vein, were depicted in 52 (52%) patients. The internal occipital vein was delineated on 99 (49.5%) sides and joined the basal vein and vein of Galen in 39 (39.4%) and 60 (60.6%) hemispheres, respectively. Comparing these results with previous angiographic studies, the ability of the neuronavigation system for depicting these vessels is similar to that of digital subtraction angiography. CONCLUSION This study illustrates the possibility of depicting the small vessels draining into the pineal region venous complex using 3-dimensional neuronavigation with an accuracy comparable to that of digital subtraction angiography. This tool provides important information for both surgical planning and intraoperative orientation.

scholarly journals Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Michael A. Cohen
Keyword(s):  
Significant Risk ◽  
Signs And Symptoms ◽  
Lateral Position ◽  
Surgical Anatomy ◽  
Pineal Region ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Vein Of Galen ◽  
Straight Sinus ◽  
Microsurgical Resection

Falcotentorial meningiomas are rare tumors of the pineal region that arise from the dural folds where the falx and tentorium meet and are often intimately related to the vein of Galen and straight sinus. These lesions often present with signs and symptoms related to hydrocephalus and brainstem compression. Surgical resection of falcotentorial meningiomas remains the definitive treatment, with a variety of surgical approaches used to resect these lesions. The choice of approach depends on several factors, including the size and location of the tumor relative to the vein of Galen complex. Falcotentorial meningiomas can be technically challenging to remove with significant risk of morbidity because of the close proximity to and occasional invasion of the vein of Galen and straight sinus. In this operative video, the authors demonstrate an illustrative step-by-step technique for endoscopic-assisted microsurgical resection of a falcotentorial meningioma using the posterior interhemispheric retrocallosal transfalcine approach for a superiorly positioned falcotentorial meningioma. The surgical nuances are discussed, including the surgical anatomy, gravity-assisted interhemispheric approach in the lateral position, retrocallosal dissection, transfalcine exposure, tumor removal, and preservation of the vein of Galen complex. In summary, the posterior interhemispheric retrocallosal transfalcine approach is a useful surgical strategy for select superiorly positioned falcotentorial meningiomas.The video can be found here: https://youtu.be/d8mdunsRacs.

scholarly journals Modified one-piece extended transbasal approach for translamina terminalis resection of retrochiasmatic third ventricular craniopharyngioma

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Skull Base ◽  
Third Ventricle ◽  
Blind Spot ◽  
Anterior Wall ◽  
Anterolateral Approach ◽  
Lamina Terminalis ◽  
Base Approach ◽  
The Third ◽  
Skull Base Approach ◽  
Midline Approach

Retrochiasmatic third ventricular craniopharyngiomas are formidable tumors to remove surgically. Access to the third ventricle can be achieved through the lamina terminalis corridor. A skull base approach to the lamina terminalis can be performed using either an anterolateral approach (orbitozygomatic, pterional, supraorbital) or a midline approach (extended transbasal, subfrontal). The major disadvantage of an anterolateral approach is the lack of visualization of the ipsilateral wall of the third ventricle and hypothalamus. However, a midline transbasal approach eliminates this blind spot thereby providing direct visualization of both ependymal walls for safe dissection of the tumor. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for translamina terminalis resection of a retrochiasmatic retroinfundibular craniopharyngioma within the third ventricle via a modified one-piece extended transbasal approach. This approach uses the standard bifrontal craniotomy and incorporates the anterior wall of the frontal sinus as a one-piece flap. The inferior limit of the osteotomy is based along the coronal contour of the anterior skull base which eliminates any bony overhang that can obstruct the line of sight to the lamina terminalis. Additional removal of the supraorbital bar is not necessary. The operative technique for this skull base approach and surgical nuances for craniopharyngioma resection are illustrated in this video atlas.The video can be found here: http://youtu.be/E3Bsp6dUdAE.

Arterio-inferior Sagittal Sinus Fistulae: Case Report

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 971-975 ◽  
Author(s):  
Michael K. Morgan ◽  
Thoralf M. Sundt ◽  
Wayne O. Houser
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Arteriovenous Malformation ◽  
Vein Of Galen ◽  
Arteriovenous Fistulae ◽  
Postoperative Course ◽  
Hyperperfusion Syndrome ◽  
Sagittal Sinus ◽  
Progressive Cognitive Impairment ◽  
Satisfactory Recovery

Abstract The management of the case of a 9-year-old boy with progressive cognitive impairment due to arteriovenous fistulae at the apex of the inferior sagittal sinus is reported. This represents a unique location for an extraparenchymal deep central arteriovenous malformation. The patient underwent staged ablation of the lesion by surgery. The postoperative course was complicated by expansion of an aneurysmal vein of Galen undergoing thrombosis and hyperperfusion syndrome, but the patient ultimately made a satisfactory recovery.

scholarly journals A genomic view of estrogen actions in human breast cancer cells by expression profiling of the hormone-responsive transcriptome

2004 ◽  
Vol 32 (3) ◽  
pp. 719-775 ◽  
Author(s):  
L Cicatiello ◽  
C Scafoglio ◽  
L Altucci ◽  
M Cancemi ◽  
G Natoli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Human Breast Cancer ◽  
Gene Activation ◽  
Chromosome 17 ◽  
Human Breast ◽  
Cellular Functions ◽  
Extracellular Milieu ◽  
Similar Expression Profile ◽  
A Site ◽  
Turn Over

Estrogen controls key cellular functions of responsive cells including the ability to survive, replicate, communicate and adapt to the extracellular milieu. Changes in the expression of 8400 genes were monitored here by cDNA microarray analysis during the first 32 h of human breast cancer (BC) ZR-75.1 cell stimulation with a mitogenic dose of 17beta-estradiol, a timing which corresponds to completion of a full mitotic cycle in hormone-stimulated cells. Hierarchical clustering of 344 genes whose expression either increases or decreases significantly in response to estrogen reveals that the gene expression program activated by the hormone in these cells shows 8 main patterns of gene activation/inhibition. This newly identified estrogen-responsive transcriptome represents more than a simple cell cycle response, as only a few affected genes belong to the transcriptional program of the cell division cycle of eukaryotes, or showed a similar expression profile in other mitogen-stimulated human cells. Indeed, based on the functions assigned to the products of the genes they control, estrogen appears to affect several key features of BC cells, including their metabolic status, proliferation, survival, differentiation and resistance to stress and chemotherapy, as well as RNA and protein synthesis, maturation and turn-over rates. Interestingly, the estrogen-responsive transcriptome does not appear randomly interspersed in the genome. In chromosome 17, for example, a site particularly rich in genes activated by the hormone, physical association of co-regulated genes in clusters is evident in several instances, suggesting the likely existence of estrogen-responsive domains in the human genome.

Anatomical features of the straight sinus and its tributaries

1976 ◽  
Vol 44 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Jefferson Browder ◽  
Harry A. Kaplan ◽  
Abbott J. Krieger
Keyword(s):  
Dura Mater ◽  
Vein Of Galen ◽  
Main Trunk ◽  
Content Type ◽  
Tentorium Cerebelli ◽  
Anatomical Features ◽  
Straight Sinus ◽  
Sagittal Sinus ◽  
Collateral Pathways ◽  
Fine Print

✓ The authors report a variety of arrangements of the venous channels comprising the straight sinus (sinus rectus) and its connections during a continuing study of the cerebral sinuses and their tributaries. In approximately 85% of 131 specimens of dura mater with enclosed venous sinuses derived from fresh cadavers, the straight sinus was represented by a single midline tentorial channel whereas in the remaining 15%, segments of it were doubled and in a few, tripled. In addition to these aberrations in the development of the main trunk of this sinus, the venous patterns at the junctions of the inferior sagittal sinus, vein of Galen and straight sinus showed comparable developmental inconstancies. Also in no specimens were the patterns of venous channels in the leaves of the tentorium cerebelli alike. The course, size, and connections of all the tributaries of the straight sinus have been studied and consideration given to their potentials as collateral pathways in the event either the vein of Galen or the straight sinus itself were occluded.

Arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx

1999 ◽  
Vol 91 (2) ◽  
pp. 303-307 ◽  
Author(s):  
John Ratliff ◽  
Rand M. Voorhies
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Left Vertebral Artery ◽  
External Carotid ◽  
Vein Of Galen ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
Sagittal Sinus ◽  
Dural Avm ◽  
Fine Print

✓ This 24-year-old man presented with an unusual case of a high-flow arteriovenous fistula (AVF). This lesion was similar to giant AVFs in children that have been previously described in the literature. In patients in whom abnormalities of the vein of Galen have been excluded and in whom presentation occurs after 20 years of age, a diagnosis of congenital AVF is quite unusual.The fistula in this case originated in an enlarged callosomarginal artery and drained into the superior sagittal sinus via a saccular vascular abnormality. Two giant aneurysmal dilations of the fistula were present. In an associated finding, a small falcine dural arteriovenous malformation (AVM) was also present. Arterial supply to the AVM arose from both external carotid arteries and the left vertebral artery, with drainage through an aberrant vein in the region of the inferior sagittal sinus into the vein of Galen.Craniotomy with exposure and trapping of the AVF was performed, with subsequent radiosurgical (linear accelerator) treatment of the dural AVM. Through this combination of microsurgical trapping of the AVF and radiotherapy of the dural AVM, an excellent clinical outcome was achieved.

scholarly journals Communication, Culture and Community: Towards A Cultural Analysis of Community Media

2015 ◽  
Author(s):  
Kevin Howley
Keyword(s):  
Cultural Studies ◽  
Cultural Production ◽  
Information Technologies ◽  
Blind Spot ◽  
Cultural Analysis ◽  
Cultural Significance ◽  
Global Media ◽  
Community Media ◽  
Interdisciplinary Approaches ◽  
A Site

This paper promotes a research agenda committed to a sustained, multiperspectival cultural analysis of community-based media. In doing so, the essay takes up two interrelated arguments. First, it is suggested that community media represent a conspicuous blind spot in cultural approaches to communication studies: a situation that is at odds with the hallmarks of cultural studies scholarship, especially its affirmation of popular forms of resistance and its celebration of and keen appreciation for local cultural production. Second, the author maintains that as a site of intense struggle over cultural production, distribution, and consumption within and through communication and information technologies, community media demand the rigorous, interdisciplinary approaches and interventionist strategies associated with the finest traditions of cultural studies scholarship. The author concludes that this research program is essential for appreciating the social, political, and cultural significance of locally oriented, participatory media in an increasingly privatized, global media environment.

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