scholarly journals Resection of a Neuroenteric Cyst Using a Far Lateral Approach

2019 ◽  
Vol 80 (S 04) ◽  
pp. S346-S347
Author(s):  
Yair M. Gozal ◽  
Hussam Abou-Al-Shaar ◽  
Vincent A. DiNapoli ◽  
Andrew J. Ringer
Keyword(s):  
Transverse Process ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Fat Graft ◽  
Elective Resection ◽  
Autologous Fat Graft ◽  
Neuroenteric Cyst ◽  
Far Lateral Approach ◽  
Far Lateral

AbstractThis operative video highlights a rare case of a neuroenteric cyst at the ventral craniocervical junction. The case involved a 30-year-old man who initially presented 13 years earlier with acute onset of headache and visual changes. At that time, he was found to have a small, enhancing ventral intradural extramedullary mass at the rostral aspect of C1 thought to be a meningioma. The lesion was managed conservatively, and surveillance imaging tracked its slow progressive enlargement to a size of 1.4 cm (Fig. 1A, B). Although he remained asymptomatic, nonurgent elective resection was recommended because of his age and mass progression. The patient underwent a left far lateral approach to the craniocervical junction for resection of the mass. This involved dissection of the suboccipital musculature to expose the C1 transverse process in the suboccipital triangle and ultimately the vertebral artery. After a small craniectomy and C1 hemilaminectomy, the dura was opened and a cystic lesion encountered (Fig. 2). The cystic contents were debulked and the capsule resected. Histopathologic examination revealed abundant goblet cells consistent with a neuroenteric cyst. Dural closure was bolstered with fascia lata and autologous fat graft. Postoperative magnetic resonance imaging (MRI) was consistent with gross total resection (Fig. 1C, D). The patient tolerated the procedure well with no new postoperative neurological deficits and was discharged home on postoperative day 2. On completing a 3-day decadron taper, he developed steroid-responsive symptoms consistent with aseptic meningitis, possibly related to cerebrospinal fluid contamination with the cyst contents during resection.The link to the video can be found at: https://youtu.be/SskETPe5PXQ.

scholarly journals Foramen Magnum Meningioma: Far Lateral Approach

2019 ◽  
Vol 80 (S 04) ◽  
pp. S363-S364
Author(s):  
Ciro Vasquez ◽  
Alexander Yang ◽  
A. Samy Youssef
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerves ◽  
Mass Effect ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Occipital Condyle ◽  
Far Lateral Approach ◽  
Far Lateral

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.

scholarly journals Resection of a Meningioma at Craniocervical Junction through Far Lateral Approach: Two-Dimensional Operative Video

2019 ◽  
Vol 80 (S 04) ◽  
pp. S358-S359
Author(s):  
Yong Yan ◽  
Hongxiang Wang ◽  
Tao Xu ◽  
Zhenyu Gong ◽  
Fan Hong ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Posterior Inferior Cerebellar Artery ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
World Health ◽  
Neurological Deficits ◽  
Who Grade ◽  
Far Lateral Approach ◽  
Far Lateral

Tumors located in the craniocervical junction region are significantly challenging for surgical resection. We shared our experience of a meningioma at craniocervical junction resected through far lateral approach in a 68-year-old female. The patient presented with intermittent headache with discomfort in the neck and shoulders for 3 years without any positive signs. Magnetic resonance imaging (MRI) revealed a tumor of 3.6 cm × 3.0 cm × 2.5 cm lying at the ventral side of medulla oblongata, with T1 hypointensity, T2 hyperintensity, and a significant enhancement on T1-contrast image. The far lateral approach on the right side was planned to resect the tumor with a park-bench position. The patient underwent a standard craniotomy using a lazy S-shaped incision. The transposition of vertebral artery was performed carefully therein, followed by removal of part of the arches of atlas and axis. After exposure of the tumor, vertebral artery (VA) and posterior inferior cerebellar artery (PICA) adhesive to the lesion could be seen operatively. Truncating the supplying blood vessels of the tumor was taken as the first step, followed by resecting the tumor mass in a piecemeal manner. While preserving VA, PICA, posterior nerves, medulla oblongata, and cervical cord, gross-total resection was achieved under the careful operation. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as a meningioma (World Health Organization [WHO] grade I). Postoperative MRI scan depicted complete resection of the tumor. The patient 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/i9H-wS4fF10.

Medulla oblongata cavernoma removal through a lazy far lateral approach: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V21
Author(s):  
Carlos Candanedo ◽  
Samuel Moscovici ◽  
Sergey Spektor
Keyword(s):  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Complete Removal ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Total Resection ◽  
Postoperative Mri ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Brainstem Cavernous Malformation

Removal of brainstem cavernous malformation remains a surgical challenge. We present a case of a 63-year-old female who was diagnosed with a large cavernoma located in the medulla oblongata. The patient suffered three episodes of brainstem bleeding resulting in significant neurological deficits (hemiparesis, dysphagia, and dysarthria). It was decided to remove the cavernoma through a left-sided modified far lateral approach.3The operative video demonstrates the surgical steps and nuances of a complete removal of this complex medulla oblongata cavernous malformation. Total resection was achieved without complications. Postoperative MRI revealed no signs of residual cavernoma with clinical improvement.The video can be found here: https://youtu.be/BTtMvvLMOFM.

Microsurgical Resection of Craniocervical Dermoid Cyst by Far Lateral Approach: Case Report and Literature Review

2018 ◽  
Vol 37 (04) ◽  
pp. 339-342
Author(s):  
Lucas Meguins ◽  
Antonio Spotti ◽  
Dionei Morais ◽  
Carlos Rocha ◽  
Ricardo Caramanti ◽  
...  
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Posterior Fossa ◽  
Symptom Control ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Uneventful Recovery ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Posterior Fossa Dermoid

Introduction Intracranial dermoid tumors represent a rare clinical entity that accounts for 0.04 to 0.6% of all intracranial tumors. Their location in the posterior fossa is uncommon. Objectives To report the case of a young woman with a posterior fossa dermoid cyst treated by right far lateral approach. Case Report A 17-year-old woman presenting with swallowing difficulties for 6 weeks was referred for a neurological investigation. A magnetic resonance imaging (MRI) scan showed a hyperintense T1-weighted large expansive lesion occupying the posterior fossa and compressing the anterior face of the brain stem and cerebellum. The patient underwent surgical treatment by right far lateral approach with decompression of vascular and neural structures. The patient presented an uneventful recovery, and was discharged home on the fourth postoperative day without any additional neurological deficits. The anatomopathological analysis confirmed the diagnosis of dermoid cyst. Conclusion The far lateral approach is a safe and feasible route to appropriately treat large posterior fossa dermoid cysts. Decompression of vascular and neural structures is essential to achieve good symptom control.

A modified far-lateral approach for large or giant meningiomas of the posterior fossa

2010 ◽  
Vol 112 (5) ◽  
pp. 907-912 ◽  
Author(s):  
Nader Sanai ◽  
Michael W. McDermott
Keyword(s):  
Posterior Fossa ◽  
Signs And Symptoms ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Cranial Neuropathy ◽  
Consecutive Series ◽  
Simpson Grade ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
The Mean

Object Resecting large meningiomas along the posterior fossa convexity or cerebellopontine angle (CPA) through a suboccipital approach can be challenging. Limitations include a restricted angle of view, high venous pressures, and suboptimal brain relaxation. While a far-lateral craniotomy is a viable alternative, the risks associated with condylar resection are undesirable. Methods The authors retrospectively evaluated a modified far-lateral approach in a consecutive series of 12 patients with large or giant posterior fossa convexity and CPA meningiomas. This approach incorporates transverse-sigmoid sinus exposure and C-1 laminectomy, but there is no condylar resection. Results Between January 2006 and February 2008, 12 patients (mean age 52 years) presented with large or giant meningiomas of the posterior fossa convexity or CPA. The mean tumor volume was 72.6 cm3 (range 8–131 cm3). Signs and symptoms at presentation included headache (in 8 patients), cranial neuropathy (in 4), and progressive hemiparesis (in 4). There were no operative complications, and the majority of patients (9) had Simpson Grade I or II resections. There were no new permanent neurological deficits following resection, although 2 patients (17%) had transient deficits. The mean modified Rankin score decreased from 2.2 preoperatively to 0.6 postoperatively. Conclusions A modified far-lateral approach to the posterior fossa and CPA allows for safe, and often total, resection of large meningiomas with minimal morbidity. While avoiding the risks of condylar resection, this microsurgical strategy allows for greater field of view, minimal venous bleeding, and immediate access to the spinal subarachnoid space.

Staged bilateral far-lateral approach for bilateral cervicomedullary junction neurenteric cysts in a 10-year-old girl

2013 ◽  
Vol 12 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Smruti K. Patel ◽  
James K. Liu
Keyword(s):  
Unusual Case ◽  
Pediatric Population ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Rare Occurrence ◽  
Benign Lesions ◽  
Far Lateral Approach ◽  
The Central Nervous System ◽  
Far Lateral ◽  
Pontomedullary Junction

Neurenteric cysts are rare and benign lesions that consist of ectopic alimentary tissue residing in the central nervous system. They tend to occur most frequently in an intraspinal rather than intracranial location. Intracranial neurenteric cysts are a rare occurrence in the pediatric population. These lesions typically present as unilateral cystic structures in the lower cerebellopontine angle and craniocervical junction. To the authors' knowledge, there have been no reported cases of bilateral localization of intracranial neurenteric cysts. In this report, they present an unusual case of a 10-year-old girl who was found to have bilateral intracranial neurenteric cysts at the pontomedullary junction. The patient was successfully treated with staged, bilateral far-lateral transcondylar resection of the cysts. The authors also provide a brief overview of the literature describing intracranial neurenteric cysts in children.

scholarly journals Resection of an anterior spinal cord AVM through a far-lateral approach

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
L. Madison Michael ◽  
Jeffrey M. Sorenson
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Altered Mental Status ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Developmentally Delayed ◽  
Stereoscopic Video ◽  
Far Lateral Approach ◽  
Far Lateral

A small arteriovenous malformation near the craniocervical junction with contributions from the anterior spinal artery was discovered in a young developmentally-delayed woman after she presented with altered mental status and evidence of subarachnoid hemorrhage. The malformation could not be completely treated with endovascular therapy, so it was resected through a far-lateral approach. This stereoscopic video demonstrates how to gain the exposure needed to address a lesion in this area. The video can be found here: http://youtu.be/ByjPGm_eXLc.

scholarly journals Schwannoma of the craniocervical junction: surgical approach of two cases

2003 ◽  
Vol 61 (3A) ◽  
pp. 639-641 ◽  
Author(s):  
Manoel Baldoino Leal Filho ◽  
Guilherme Borges ◽  
Arnaldo Ferreira ◽  
Daniel França ◽  
Patricia Mello
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Special Focus ◽  
Sitting Position ◽  
Far Lateral Approach ◽  
Far Lateral

We report two cases of craniocervical junction schwannomas with a special focus on the surgical approach. The patients underwent a far-lateral approach in the sitting position that facilitated the lesion removal. This report is meant to improve the understanding of this surgical technique as well as improve awareness of its usefulness for similar cases.

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