Management of Intradural Anterolateral Meningiomas of the Foramen Magnum with the Posterolateral (Far-Lateral) Retrocondylar or Partial Transcondylar Approach: Learning from Experience in 26 Consecutive Cases

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
Benoit Pirotte ◽  
Michael Bruneau ◽  
Jacques Brotchi ◽  
Olivier Witte
Keyword(s):  
Foramen Magnum ◽  
Learning From Experience ◽  
Transcondylar Approach ◽  
Far Lateral

Far Lateral Transcondylar Approach for Lesions of the Foramen Magnum

2003 ◽  
Vol 9 (2) ◽  
pp. 93-105 ◽  
Author(s):  
Evandro de Oliveira ◽  
Hung Tzu Wen ◽  
Helder Tedeschi ◽  
Albert L. Rhoton, ◽  
Fabricio Carrijo Rodrigues ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Transcondylar Approach ◽  
Far Lateral

scholarly journals Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions

2020 ◽  
Vol 24 (2) ◽  
pp. 149-155
Author(s):  
WAQAS MEHDI ◽  
AZAM NIAZ ◽  
MUHAMMAD IRFAN ◽  
SHAHZAIB TASDIQUE ◽  
SAMRA MAJEED
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Initial Assessment ◽  
Cervical Cord ◽  
Total Excision ◽  
Cardiorespiratory Arrest ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Far Lateral ◽  
Malignant Lesions

Objective:  To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute. Material and Methods:  We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach. Result:  Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage. Conclusion:  This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach. Keywords:  Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma.

scholarly journals Far-lateral transcondylar approach to anterior foramen magnum lesions - Our experience

2018 ◽  
Vol 13 (3) ◽  
pp. 651
Author(s):  
SBalaji Pai ◽  
G Raghuram ◽  
GC Keshav ◽  
Elvis Rodrigues
Keyword(s):  
Foramen Magnum ◽  
Transcondylar Approach ◽  
Far Lateral

Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

2019 ◽  
Vol 1 (2) ◽  
pp. V3
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Duarte N. C. Cândido ◽  
Wladimir O. Melo ◽  
Marcio S. Rassi ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Three Dimensional ◽  
Foramen Magnum ◽  
Complete Resection ◽  
Neurophysiological Monitoring ◽  
Cervical Instability ◽  
Transcondylar Approach ◽  
Postoperative Mri ◽  
Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

Histology of the vertebral artery–dural junction: relevance to posterolateral approaches to the skull base

2019 ◽  
pp. 1-6
Author(s):  
Robert C. Rennert ◽  
Martin P. Powers ◽  
Jeffrey A. Steinberg ◽  
Takanori Fukushima ◽  
John D. Day ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Vertebral Artery ◽  
Skull Base ◽  
Histological Analysis ◽  
Foramen Magnum ◽  
Entry Site ◽  
Microsurgical Technique ◽  
Vessel Injury ◽  
Far Lateral ◽  
Clear Delineation

OBJECTIVEThe far-lateral and extreme-lateral infrajugular transcondylar–transtubercular exposure (ELITE) and extreme-lateral transcondylar transodontoid (ELTO) approaches provide access to lesions of the foramen magnum, inferolateral to mid-clivus, and ventral pons and medulla. A subset of pathologies in this region require manipulation of the vertebral artery (VA)–dural interface. Although a cuff of dura is commonly left on the VA to avoid vessel injury during these approaches, there are varying descriptions of the degree of VA-dural separation that is safely achievable. In this paper the authors provide a detailed histological analysis of the VA-dural junction to guide microsurgical technique for posterolateral skull base approaches.METHODSAn ELITE approach was performed on 6 preserved adult cadaveric specimens. The VA-dural entry site was resected, processed for histological analysis, and qualitatively assessed by a neuropathologist.RESULTSHistological analysis demonstrated a clear delineation between the intima and media of the VA in all specimens. No clear plane was identified between the connective tissue of the dura and the connective tissue of the VA adventitia.CONCLUSIONSThe VA forms a contiguous plane with the connective tissue of the dura at its dural entry site. When performing posterolateral skull base approaches requiring manipulation of the VA-dural interface, maintenance of a dural cuff on the VA is critical to minimize the risk of vascular injury.

scholarly journals Far Lateral Craniotomy for Resection of Foramen Magnum Meningioma

2019 ◽  
Vol 80 (S 04) ◽  
pp. S355-S357
Author(s):  
Robert T. Wicks ◽  
Xiaochun Zhao ◽  
Celene B. Mulholland ◽  
Peter Nakaji
Keyword(s):  
Cranial Nerves ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Formidable Challenge ◽  
Close Proximity ◽  
Vertebrobasilar Circulation ◽  
Far Lateral ◽  
Lower Cranial Nerves ◽  
Gain Access

Abstract Objective Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma. Design, Setting, and Participant A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma (Fig. 1A, B). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology. Outcome/Result Maximal total resection of the tumor was achieved (Fig. 1B, C), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection (Fig. 2) is shown in the video. Conclusion Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates.The link to the video can be found at: https://youtu.be/Mds9N1x2zE0.

Far Lateral Transcondylar Approach: Dimensional Anatomy

Neurosurgery ◽  
1999 ◽  
Vol 45 (1) ◽  
pp. 95-100 ◽  
Author(s):  
Gregory C. Dowd ◽  
Steve Zeiller ◽  
Deepak Awasthi
Keyword(s):  
Transcondylar Approach ◽  
Far Lateral
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