scholarly journals Combined Petrosal Approach for Resection of Petroclival Meningioma with Endoscopic Assistance: Operative Video and Technical Nuances

2019 ◽  
Vol 80 (S 03) ◽  
pp. S292-S293
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Skull Base ◽  
Petrous Bone ◽  
Dural Defect ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Hearing Function ◽  
Endoscopic Assistance ◽  
Anterior Petrosectomy ◽  
Microsurgical Resection ◽  
Neurovascular Structures

Petroclival meningiomas are formidable lesions due to their deep location in the skull base and proximity to critical neurovascular structures. The combined petrosal approach, comprised of an anterior petrosectomy and posterior retrolabyrinthine petrosectomy, allows for both supra- and infratentorial exposure of the tumor in the petroclival region while potentially preserving hearing function (Fig. 1). In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petroclival meningioma via the combined petrosal approach. The nuances of microsurgical and skull base technique are illustrated including drilling of the petrous bone, transecting the tentorium, resection of the tumor, and multilayered reconstruction of the dural defect. The combined petrosal approach allows for multiple angles of attack including both subtemporal and presigmoid corridors. In summary, the combined petrosal approach with endoscopic assistance is an important strategy in the armamentarium for surgical resection of petroclival meningiomas (Fig. 2).The link to the video can be found at: https://youtu.be/ipZb9kHcP2g.

Presigmoid transpetrous approach (partial petrosectomy) combined with subtemporal transtentorial approach for petroclival meningioma

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Fernando Palacios ◽  
◽  
Manuel Lazón ◽  
Eduardo Romero ◽  
Rommel Rodriguez
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Intraoperative Complications ◽  
Brain Magnetic Resonance Imaging ◽  
Complete Resection ◽  
Neurosurgical Procedures ◽  
Resonance Imaging ◽  
Petroclival Meningioma ◽  
Skull Base Neoplasms ◽  
Petroclival Meningiomas

Introduction: Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using a combined presigmoid and subtemporal transtentorial transpetrosal approach. Clinical case: 33-year-old female patient with a clinical picture of headache, nausea, and gait disturbance. Brain magnetic resonance imaging showed a large right petroclival tumor (4.2x3.9x3.8cm) that displaced the brainstem and secondary hydrocephalus. The hydrocephalus was treated with a ventricular peritoneal shunt. Then, the tumor was resected using a combined presigmoid and subtemporal transpetrosal approach, a technique that allowed adequate exposure of the tumor, achieving complete resection, without intraoperative complications. Postoperative evolution was favorable, with no sequelae. Conclusion: The combined presigmoid and transtentorial subtemporal transpetrous approach for petroclival meningiomas is an effective and feasible technique to perform in our environment. The support of technology such as Neuronavigation, the ultrasonic aspirator, intraoperative monitoring, and adequate experience in skull base surgery are fundamental factors for the success of this surgery. Keywords: Meningioma, Skull Base Neoplasms, Craniotomy, Neurosurgical Procedures. (Source: MeSH NLM)

Arachnoid Cyst Confined to the Internal Auditory Canal—Endoscope-Assisted Resection: Case Report and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E267-E270 ◽  
Author(s):  
Steffen Kristian. Fleck ◽  
Jörg. Baldauf ◽  
Soenke. Langner ◽  
Silke. Vogelgesang ◽  
Henry Werner. Siegfried Schroeder
Keyword(s):  
Arachnoid Cyst ◽  
Cyst Wall ◽  
Internal Auditory Canal ◽  
Rare Condition ◽  
Nerve Fibers ◽  
Neurological Deficits ◽  
Microsurgical Technique ◽  
Endoscopic Assistance ◽  
Microsurgical Resection ◽  
Neurovascular Structures

abstract BACKGROUND AND IMPORTANCE: An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion. CLINICAL PRESENTATION: A slowly progressive hearing loss developed in a 35-year-old woman over 2 years; she reported experiencing tinnitus for 7 years. Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst. INTERVENTION: The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The histological examination confirmed the diagnosis of an arachnoid cyst. CONCLUSION: The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits.

scholarly journals Extended middle fossa approach with anterior petrosectomy for resection of upper petroclival meningioma involving Meckel’s cave: operative video and technical nuances

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V8 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Surgical Management ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Petroclival Meningioma ◽  
Middle Fossa Approach ◽  
Petroclival Meningiomas ◽  
Meckel's Cave ◽  
Anterior Petrosectomy

The surgical management of petroclival meningiomas remains a formidable challenge. These tumors are deep in the base of the skull and arise medial to the fifth cranial nerve. In this operative video, the author demonstrates the extended middle fossa approach with anterior petrosectomy to resect an upper petroclival meningioma extending into Meckel’s cave with brainstem compression. This approach is very useful for accessing deep tumors located above and below the tentorium, and between the fifth and seventh cranial nerves. Access to Meckel’s cave is readily achieved by opening the fibrous ring of the porous trigeminus. This video demonstrates the operative technique and surgical nuances of the skull base approach, useful anatomic landmarks of the middle fossa rhomboid for safe petrosectomy drilling, pearls for cranial nerve and neuro-otologic preservation, and exposure of Meckel’s cave. A gross-total resection was achieved, and the patient was neurologically intact. In summary, the extended middle fossa approach with anterior petrosectomy is an important strategy in the armamentarium for surgical management of petroclival meningiomas.The video can be found here: https://youtu.be/jttwJIYPHC8.

scholarly journals Combined Presigmoid and Retrosigmoid Approach to Petroclival Meningiomas

2018 ◽  
Vol 79 (S 05) ◽  
pp. S402-S403
Author(s):  
Marcio Rassi ◽  
Johnni Zamponi ◽  
Duarte Cândido ◽  
Jean Oliveira ◽  
Gustavo Passos ◽  
...  
Keyword(s):  
Skull Base ◽  
Venous Drainage ◽  
Clinical History ◽  
Jugular Bulb ◽  
Retrosigmoid Approach ◽  
Limiting Factor ◽  
Posterior Aspect ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Transtentorial Approach

Introduction The management of petroclival meningiomas is among the most intimidating in neurosurgery, due to its difficult accessibility and close relationship with vital structures; therefore, an appropriate exposure is mandatory. We present a surgical video demonstrating a presigmoid transtentorial approach, associated with the opening of the retrosigmoid dura to a petroclival meningioma, performed by the senior surgeon (L.A.B.B.), along with its indications and pitfalls. Approach Decision The patient's clinical history is summed to the tumor's radiological features as its extension, vascularization, and venous drainage, when selecting the appropriate approach. The presigmoid transtentorial approach offers a wide exposure of the petroclival area along with the tumor's attachment. Its association with the retrosigmoid route allows the surgeon to freely work through multiple paths, and parallel to the skull base, reducing the traction in the temporal lobe. Clinical Case This is a 39-year-old female presenting with trigeminal neuralgia. Imaging depicted a petroclival meningioma, extending from the posterior aspect of the cavernous sinus to the cerebellopontine angle, extending inferiorly to the jugular bulb. A Simpson II resection was achieved through a combined presigmoid and retrosigmoid approach, and the patient was discharged with no complications or new deficits. Conclusion Petroclival meningiomas are a formidable and surgically treatable disease. The appropriate approach is design to each patient and should not be the limiting factor for total tumor removal, which is truly given by the absence of a dissection plane between the tumor and the brainstem, nerves and vascular structures of the skull base.The link to the video can be found at: https://youtu.be/MFjqZvElBSo.

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.

scholarly journals Staged Approach for Petroclival Meningioma Resection

2019 ◽  
Vol 80 (S 03) ◽  
pp. S308-S309
Author(s):  
Georgios Klironomos ◽  
Amrit Chiluwal ◽  
Amir Reza Dehdashti
Keyword(s):  
Residual Tumor ◽  
Neurological Deficits ◽  
Surgical Morbidity ◽  
Inferior Pole ◽  
Petroclival Meningioma ◽  
Left Behind ◽  
Petroclival Meningiomas ◽  
Staged Approach ◽  
Anterior Petrosectomy ◽  
Magnetic Resonance Imaging Mri

Introduction Petroclival meningiomas represent very uncommon and challenging tumors. Surgical morbidity is high due to the difficult and complex approaches to this area. In the present video presentation, we demonstrate a staged-approach surgical resection for petroclival meningioma. Patient and Methods A 47-year- old female was incidentally diagnosed with right sizable petroclival meningioma (Fig. 1). The decision to proceed with a staged approach was made based on size and extension of the tumor to both the middle and posterior fossa. At the first stage we performed a right anterior petrosectomy with the patient in the supine position and the head turned 45 degrees to the left. Residual tumor was left behind along its inferior pole. At the second stage, 2 weeks after the 1st surgery, a right retrosigmoid craniotomy was performed with the patient placed on left park-bench position and the residual tumor was removed. The patient tolerated both stages very well without significant neurological deficits except a transient diplopia after the first stge. Postoperative magnetic resonance imaging (MRI) revealed gross total resection of the tumor. Conclusion Staged approach for petroclival meningiomas represents a safe and effective surgical management, tolerable for the patient and more comfortable for the neurosurgeon.The link to the video can be found at: https://youtu.be/QJJchjAwD5c.

scholarly journals Posterior petrosal approach for microsurgical resection of petroclival meningioma: 3-Dimensional operative video

2021 ◽  
Vol 12 ◽  
pp. 324
Author(s):  
Guilherme Henrique Weiler Ceccato ◽  
Rodolfo Frank Munhoz da Rocha ◽  
Anderson Matsubara ◽  
Luis Alencar Biurrum Borba
Keyword(s):  
Lateral Position ◽  
Jugular Foramen ◽  
Neurological Deficits ◽  
Preoperative Imaging ◽  
Neurophysiological Monitoring ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Close Relationship ◽  
Superior Petrosal Sinus ◽  
Microsurgical Resection

Background: Petroclival meningiomas are challenging lesions considering their deep location and close relationship with many vital neurovascular structures.[1-8] Case Description: We present the case of a 54-year-old male presenting a history of headache, dizziness, and tinnitus on the left side, associated with left facial hypoesthesia. Preoperative imaging depicted a lesion highly suggestive of a petroclival meningioma with important compression of the brainstem. Considering worsening of symptoms, size, and location of this lesion, microsurgical resection was indicated. A left posterior petrosal approach was employed with aid of neurophysiological monitoring. The patient was placed in a true lateral position and an arciform incision was done. First, the mastoidectomy was performed and then the craniotomy around encompassing both posterior and middle cranial fossae. Middle and posterior fossa dural incisions were connected through coagulation of the superior petrosal sinus. Then tentorium was all the way cut to the incisura. After that, sigmoid sinus can be mobilized posteriorly, increasing exposure of presigmoid space. The area since jugular foramen up to the supratentorial region was fully exposed, allowing safe total resection of the lesion. Postoperative imaging demonstrated complete tumor removal. Patient presented improvement of symptoms, with no new neurological deficits on follow-up. Conclusion: The posterior petrosal approach provided a shorter pathway and direct angle of attack to the tumor attachment, allowing successful resection.[1,6] Extensive laboratory training is essential to get familiarized with the complex anatomical relationships in that area. Informed consent was obtained from the patient for the procedure and publication of this operative video.

scholarly journals Resection of middle petroclival meningioma via combined anterior transpetrosal and retrosigmoid approaches at two separate stages: 3D operative video

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V12 ◽  
Author(s):  
Ihsan Dogan ◽  
Pinar Eser Ocak ◽  
G. Mark Pyle ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Male Patient ◽  
Individual Case ◽  
Surgical Approaches ◽  
Petroclival Meningioma ◽  
The Past ◽  
Surgical Access ◽  
Petroclival Meningiomas ◽  
Wide Range ◽  
History Of

Surgical access to the petroclival region poses a challenge to neurosurgeons. A wide range of approaches has been demonstrated in the past. In this video, the authors present a 69-year-old male patient who presented with 3-month history of worsening left-sided numbness. The tumor was totally removed in 2 sessions via anterior transpetrosal and retrosigmoid approaches, respectively. The authors demonstrate 2 separate skull base approaches to resect a petroclival meningioma and discuss pitfalls and problems of management for challenging meningiomas. The authors suggest that surgical approaches to petroclival meningiomas should be selected based on an individual case. A skull base team should be versatile in performing all these approaches.The video can be found here: https://youtu.be/BCVrn3TeNvE.

scholarly journals Cranial base strategies for resection of craniopharyngioma in children

2005 ◽  
Vol 18 (6) ◽  
pp. 1-9 ◽  
Author(s):  
James K. Liu ◽  
Chad D. Cole ◽  
John R. W. Kestle ◽  
Douglas L. Brockmeyer ◽  
Marion L. Walker
Keyword(s):  
Skull Base ◽  
Postoperative Morbidity ◽  
Hormone Replacement ◽  
Total Removal ◽  
Complete Excision ◽  
Skull Base Approach ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Surgical Corridor ◽  
Neurovascular Structures

The optimal treatment of craniopharyngioma in children remains a challenge. The use of complete excision to minimize recurrence continues to be controversial because of the risk of postoperative morbidity and death. Advances in skull base approaches, modern microsurgical techniques, neuroimaging, and hormone replacement therapy, however, have allowed safe gross- or near-total resection in the majority of cases. Total removal of these tumors, if possible, offers the best chance of cure for the patient. Although craniopharyngiomas are not strictly tumors of skull base origin, their intimate relationship with the neurovascular structures of this region often requires a skull base approach to maximize the surgical corridor and facilitate adequate microsurgical resection. In this review, the authors focus on commonly used skull base approaches for the surgical management of craniopharyngioma. They discuss the relative indications, advantages, disadvantages, and complications associated with each approach. Illustrative cases and intra-operative videos are presented.

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