Endoscopic Endonasal and Transcranial Surgery for Microsurgical Resection of Ventral Foramen Magnum Meningiomas: A Preliminary Experience

2017 ◽  
Vol 14 (5) ◽  
pp. 503-514 ◽  
Author(s):  
Nicolas Khattar ◽  
Maria Koutourousiou ◽  
Joseph D Chabot ◽  
Eric W Wang ◽  
Aaron A Cohen-Gadol ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Foramen Magnum ◽  
Gross Total Resection ◽  
Fat Graft ◽  
Karnofsky Performance Scale ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Lower Cranial Nerve

Abstract BACKGROUND Purely ventral foramen magnum meningiomas are challenging tumors to treat given their location, and proximity and relationship to vital neurovascular structures. OBJECTIVE To present endoscopic endonasal surgery (EES) as a complementary approach to the far-lateral suboccipital approach (FLA) for ventral midline tumors. METHODS From May 2008 to October 2013, 5 patients underwent EES and 5 FLA for primary ventral foramen magnum meningiomas. We retrospectively reviewed their records to evaluate outcomes. RESULTS Nine of 10 patients presented with long-tract and lower cranial nerve deficits. All patients who presented with deficits preoperatively completely normalized after tumor resection regardless of approach. Gross total resection was achieved in 2 cases in the EES group and 4 cases in the FLA group (the rest were near total). Vascular encasement was a limitation to gross total resection with both approaches. Preoperative median Karnofsky Performance Scale score was 80 and improved to 100 in both groups. Following EES, 1 patient developed cerebrospinal fluid leak with resultant meningitis. Two patients developed hydrocephalus, one of which developed an epidural abscess following necrosis of the nasoseptal flap, requiring debridement. In the FLA group, 1 patient developed a pseudomeningocele associated with hydrocephalus. One patient developed an abdominal fat graft site hematoma. CONCLUSION Both approaches provide excellent results for resection of ventral foramen magnum meningiomas, with reconstruction and hydrocephalus as the main sources of complication. In our practice, EES is a preferred technique in ventral, purely midline tumors with limited inferior extension and reduced lower cranial nerve manipulation, whereas FLA is preferred in tumors with lateral and caudal extension below the tip of the dens.

scholarly journals Meningiomas of the ventral foramen magnum

1999 ◽  
Vol 6 (6) ◽  
pp. E7 ◽  
Author(s):  
Kenan I. Arnautovic ◽  
Ossama Al-Mefty ◽  
Muhamed Husain
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Favorable Influence ◽  
Prolonged Hospital

Meningiomas of the ventral foramen magnum are rare lesions that account for less than 3% of all meningiomas. Their treatment remains one of the most challenging among all meningiomas. The authors comprehensively analyzed multiple features in the series of patients who harbored these lesions. The authors conducted a retrospective study of 18 patients who harbored lesions in the ventral foramen magnum (mean follow up 40 months) in whom surgery was performed via a transcondylar approach. Sixteen patients underwent surgery for the first time: in 12 patients (75%) gross total, in two (12.5%) near total, and in two (12.5%) subtotal tumor removal was achieved. The remaining two patients were treated for a recurrent tumor. Karnofsky Performance Scale (KPS) scores obtained at follow-up review demonstrated statistically significant improvement compared with those obtained preoperatively. The extent of surgical resection and preoperative KPS score were variables that demonstrated statistically significant favorable influence on outcomes. Ninth and 10th cranial nerve palsies were the most common complication that contributed to the prolonged hospital stay; six patients who experienced nerve palsy preoperatively worsened postoperatively, and four other patients developed nerve palsy after surgery. There were no perioperative deaths. Four patients died during the follow-up period. One patient died of multiple myeloma; another, who underwent surgery for a recurrent tumor, died 3 years after this second surgery from new tumor recurrence at 80 years of age; and the remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Meningioma of the ventral foramen magnum can be radically removed in a majority of patients in whom complications will be frequent but transient, resulting from lower cranial nerve palsies. The radical removal of a recurrent tumor provides for the patient a relatively long, stable follow-up period. Patients presenting with a low KPS score have a poor prognosis. Early diagnosis and treatment are recommended.

scholarly journals Petroclival Meningiomas: Factors Determining the Choice of Approach

2017 ◽  
Vol 79 (04) ◽  
pp. 367-378 ◽  
Author(s):  
Gustavo Isolan ◽  
Sâmia Wayhs ◽  
Guilherme Lepski ◽  
Leandro Dini ◽  
Joel Lavinsky
Keyword(s):  
Tumor Progression ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Retrosigmoid Approach ◽  
University Hospital ◽  
Gross Total Resection ◽  
Middle Fossa ◽  
Total Resection ◽  
Petroclival Meningiomas

Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Design Retrospective review. Setting The study was conducted in a university hospital in southern Brazil. Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6–75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.

scholarly journals Microsurgical resection of an enlarging lateral pontomedullary cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V24
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel-Castilla
Keyword(s):  
Cranial Nerve ◽  
Cavernous Malformation ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Lateral Aspect ◽  
Total Resection ◽  
Lower Cranial Nerve ◽  
Postoperative Mri ◽  
Microsurgical Resection ◽  
Pontomedullary Junction

The extended retrosigmoid approach provides an excellent corridor to the lateral aspect of the pontomedullary junction (PMJ).1,2 This video demonstrates a microsurgical resection of a progressive enlarging cavernous malformation (CM) of the PMJ. The patient is a 33-year-old woman with progressive symptoms, including right facial droop, left hemianesthesia, diplopia, and nystagmus. The patient underwent a right extended retrosigmoid approach with intraoperative neuronavigation and neuromonitoring. Lower cranial nerve dissection allowed access to the lateral PMJ. A longitudinal corticotomy was performed above the glossopharyngeal. The CM was removed in a piecemeal fashion. Postoperative MRI confirmed gross-total resection and the patient remained neurologically stable.The video can be found here: https://youtu.be/K_TtiTo1RsQ.

Ventral foramen magnum meningiomas

2000 ◽  
Vol 92 (1) ◽  
pp. 71-80 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
Muhammad Husain
Keyword(s):  
Cranial Nerve ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Extent Of Surgery ◽  
Prolonged Hospital ◽  
Fine Print

Object. Ventral foramen magnum meningiomas (VFMMs) are rare lesions that account for more than 3% of all meningiomas. These are among the most challenging of all meningiomas to treat. The authors comprehensively analyzed multiple features in a series of VFMMs. Methods. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum (mean follow-up period, 40 months) and underwent surgery via a transcondylar approach. Sixteen patients underwent surgery for the first time: 12 underwent gross-total (75%), two near-total (12.5%), and two subtotal (12.5%) tumor removal. The remaining two patients were treated for a recurrent tumor. After obtaining postoperative Karnofsky Performance Scale (KPS) scores at follow up, statistically significant improvement was demonstrated compared with the preoperative scores. The extent of surgery and higher preoperative KPS scores were variables that showed statistically significant favorable influence on outcome. Ninth and 10th cranial nerve deficits were the most common complications contributing to a prolonged hospital stay. There were no perioperative deaths. Four patients died during the follow-up period. The first patient died of multiple myeloma. The second patient, in whom surgery was performed to treat a recurrent tumor, died 3 years after the surgery of new tumor recurrence at the age of 80 years. The remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Conclusions. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with frequent but transient morbidity caused by lower cranial nerve deficits. Radical removal of a recurrent tumor provides a relatively long, stable postoperative course. In patients presenting with a low KPS score a poor prognosis is demonstrated, and early diagnosis and treatment are recommended to avoid it.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

scholarly journals The Sitting Position in Neurosurgery: A Clinical Study in 30 Cases

2013 ◽  
Vol 28 (1) ◽  
pp. 45-51
Author(s):  
Shamsul Alam ◽  
ATM Mossaraf Hossain ◽  
Rezaul Amin ◽  
ANM Wakil ◽  
KM Tarikul Islam ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Pineal Region ◽  
Close Monitoring ◽  
Sitting Position ◽  
Lower Cranial Nerve ◽  
Tumour Removal ◽  
Almost All

Objective: Sitting position for operation of posterior fossa lesions, occipital and posterior parietal lesions, foramen magnum, upper cervical spinal lesions provides an excellent visualization because of slack of brain due to gravity drainage of CSF and blood. Hence gross total tumour removal relatively easy and less complicative.Methods: From January 2008 to march 2010 total 30 cases underwent neurosurgical procedure in sitting position. Physical characteristics including patients age, sex, size of the tumour and histological diagnosis were collected. The post operative image were studied to see the extent of tumour removal and early detection of complications. Almost all patients required peroperative cerebral venous line or peripheral inserted central venous line, precordial doppler sound, ETCO2, O2 saturation and close monitoring of blood pressure.Results: Venous air embolism were detected in two cases (6.6%). Total tumour removal was possible in 17 (56.6%) cases and subtotal in 11 (36.6%) cases. There were 4 (13.33%) mortality in thirty cases, two cases from CP angle tumour and another case from petroclival meningioma and another from pineal region tumour. There was pneumocephalus in almost all cases and post-operative new facial paresis in 10 (33.3%) cases. Fifth cranial nerve palsy developed in 3 (10%) cases. Temporary lower cranial nerve palsy developed in 2 cases. Post-operative tumour bed haematoma developed in 4 (13.33%) cases. Most of the patient had good outcome (GOS 5).Conclusion: Sitting position can be safely done with good preoperative physiological, peroperative close monitoring of the patient regarding blood pressure, ETCO2 and oxygen saturation. However postoperative complication like tumour bed haematoma, pneumocephalus, cranial nerve palsy have to be bring in mind.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 45-51

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Microsurgical Resection of Cervical Intradural Juxtamedullary Solitary Fibrous Tumor: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E532-E532
Author(s):  
Paolo Perrini ◽  
Davide Tiziano Di Carlo ◽  
Nicola Montemurro ◽  
Nicola Benedetto ◽  
Valerio Ortenzi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Nerve Root ◽  
Tumor Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Neurophysiologic Monitoring ◽  
Intramedullary Lesion ◽  
Dural Attachment ◽  
Fibrous Tumor ◽  
Nerve Root Involvement

Abstract Solitary fibrous tumors (SFTs) are uncommon mesenchymal lesions originally described as pleura-based neoplasms. Intradural juxtamedullary SFTs are rare, hard, and scarcely vascularized and generally present a conspicuous extramedullary exophytic component without dural attachment and nerve root involvement. Gross-total resection is the mainstay of treatment, although the absence of an arachnoidal plane and the firm adherence to the spinal cord make resection challenging.  We describe the case of a 74-yr-old female patient presenting with a history of progressive spastic tetraparesis due to a cervical juxtamedullary SFT. The patient was not able to walk and magnetic resonance imaging (MRI) of the cervical spine demonstrated a possible intramedullary lesion at C2-C3 with homogeneous enhancement after gadolinium injection. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. The patient underwent C2-C3 laminoplasty and tumor resection under neurophysiologic monitoring. The tumor presented extremely hard without dural attachment or nerve root involvement and was progressively debulked using microsurgical techniques and ultrasonic aspirator. The identification of a plane between the mass and the spinal cord white matter allowed for a gross total resection. Permanent pathological analysis eventually demonstrated SFT. The patient's neurological condition was unchanged postoperatively. MRI performed 2 mo after the operation demonstrated gross total resection of the lesion. At the 6-mo follow-up visit, the patient was able to walk with assistance.  The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.

Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

2014 ◽  
Vol 10 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Malik Zaben ◽  
Mohsin Zafar ◽  
Shafqat Bukhari ◽  
Paul Leach ◽  
Charoline Hayhurst
Keyword(s):  
Malignant Tumor ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Transsphenoidal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
One Year ◽  
Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

scholarly journals Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension

2014 ◽  
Vol 37 (4) ◽  
pp. E13 ◽  
Author(s):  
Paulo M. Mesquita Filho ◽  
Leo F. S. Ditzel Filho ◽  
Daniel M. Prevedello ◽  
Cristian A. N. Martinez ◽  
Mariano E. Fiore ◽  
...  
Keyword(s):  
Skull Base ◽  
Posterior Fossa ◽  
Cerebellopontine Angle ◽  
Tumor Resection ◽  
Petrous Bone ◽  
Petrous Apex ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Female Ratio ◽  
Male Female Ratio

Object Skull base chondrosarcomas are slow-growing, locally invasive tumors that arise from the petroclival synchondrosis. These characteristics allow them to erode the clivus and petrous bone and slowly compress the contents of the posterior fossa progressively until the patient becomes symptomatic, typically from cranial neuropathies. Given the site of their genesis, surrounded by the petrous apex and the clival recess, these tumors can project to the middle fossa, cervical area, and posteriorly, toward the cerebellopontine angle (CPA). Expanded endoscopic endonasal approaches are versatile techniques that grant access to the petroclival synchondrosis, the core of these lesions. The ability to access multiple compartments, remove infiltrated bone, and achieve tumor resection without the need for neural retraction makes these techniques particularly appealing in the management of these complex lesions. Methods Analysis of the authors’ database yielded 19 cases of skull base chondrosarcomas; among these were 5 cases with predominant CPA involvement. The electronic medical records of the 5 patients were retrospectively reviewed for age, sex, presentation, pre- and postoperative imaging, surgical technique, pathology, and follow-up. These cases were used to illustrate the surgical nuances involved in the endonasal resection of CPA chondrosarcomas. Results The male/female ratio was 1:4, and the patients’ mean age was 55.2 ±11.2 years. All cases involved petrous bone and apex, with variable extensions to the posterior fossa and parapharyngeal space. The main clinical scenario was cranial nerve (CN) palsy, evidenced by diplopia (20%), ptosis (20%), CN VI palsy (20%), dysphagia (40%), impaired phonation (40%), hearing loss (20%), tinnitus (20%), and vertigo/dizziness (40%). Gross-total resection of the CPA component of the tumor was achieved in 4 cases (80%); near-total resection of the CPA component was performed in 1 case (20%). Two patients (40%) harbored high-grade chondrosarcomas. No patient experienced worsening neurological symptoms postoperatively. In 2 cases (40%), the symptoms were completely normalized after surgery. Conclusions Expanded endoscopic endonasal approaches appear to be safe and effective in the resection of select skull base chondrosarcomas; those with predominant CPA involvement seem particularly amenable to resection through this technique. Further studies with larger cohorts are necessary to test these preliminary impressions and to compare their effectiveness with the results obtained with open approaches.

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