Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E9-E9
Author(s):  
Paul A Gardner
Keyword(s):  
Cranial Nerve ◽  
Nerve Compression ◽  
Dorello’S Canal ◽  
Microsurgical Resection

Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E8-E8 ◽  
Author(s):  
Abdulrahman Alturki ◽  
Alejandro Enriquez-Marulanda ◽  
Raghav Gupta ◽  
Ajith J Thomas ◽  
Christopher S Ogilvy
Keyword(s):  
Cranial Nerve ◽  
Complete Resection ◽  
Resonance Imaging ◽  
Dorello’S Canal ◽  
Suboccipital Craniectomy ◽  
Operative Case ◽  
Patient Consent ◽  
History Of ◽  
Microsurgical Resection ◽  
The Right

Abstract We describe the case of a 73-yr-old female patient with a 2-yr history of diplopia that has progressively become worse. Physical examination revealed a right VI cranial nerve (CN) palsy. Magnetic resonance imaging and angiography showed a dolichoectatic basilar artery near the VI CN. A suboccipital craniectomy was performed, initially with the intention to perform a microvascular decompression; however, a red mass was encountered at the entrance of the right Dorello's canal that was compressing the VI CN. Complete resection of the lesion was done and decompression of the nerve was accomplished. In the following video illustration, we narrate this operative case and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

scholarly journals Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterolateral Approach ◽  
Left Vertebral Artery ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Two Dimensional ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

scholarly journals Delayed Pneumocephalus-Induced Cranial Neuropathy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Neena I. Marupudi ◽  
Monika Mittal ◽  
Sandeep Mittal
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Nerve Compression ◽  
Neurological Deficits ◽  
Oculomotor Nerve Palsy ◽  
Cranial Neuropathy ◽  
Cranial Nerve Deficit ◽  
Moderate Amount ◽  
Interpeduncular Cistern

Pneumocephalus is a common occurrence after cranial surgery, with patients typically remaining asymptomatic from a moderate amount of intracranial air. Postsurgical pneumocephalus rarely causes focal neurological deficits; furthermore, cranial neuropathy from postsurgical pneumocephalus is exceedingly uncommon. Only 3 cases have been previously reported that describe direct cranial nerve compression from intracranial air resulting in an isolated single cranial nerve deficit. The authors present a patient who developed dysconjugate eye movements from bilateral oculomotor nerve palsy. Direct cranial nerve compression occurred as a result of postoperative pneumocephalus in the interpeduncular cistern. The isolated cranial neuropathy gradually recovered as the intracranial air was reabsorbed.

scholarly journals Strategical implications of aneurysmal cranial nerve compression

2012 ◽  
Vol 58 (2-3) ◽  
pp. 146-150 ◽  
Author(s):  
F. Scholtes ◽  
D. Martin
Keyword(s):  
Cranial Nerve ◽  
Nerve Compression

Does Prior Microsurgery Improve or Worsen the Outcomes of Stereotactic Radiosurgery for Cavernous Sinus Meningiomas?

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 401-410 ◽  
Author(s):  
Hideyuki Kano ◽  
Kyun-Jae Park ◽  
Douglas Kondziolka ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Improvement Rate ◽  
Cranial Nerve Function ◽  
Cranial Neuropathies ◽  
Microsurgical Resection

Abstract BACKGROUND: Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas. OBJECTIVE: To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery. METHODS: During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm3 and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months). RESULTS: The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function. CONCLUSION: SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.

scholarly journals Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms

2018 ◽  
Vol 128 (6) ◽  
pp. 1830-1838 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Ethan A. Winkler ◽  
George F. Lasker ◽  
John K. Yue ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cranial Nerve ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Abducens Nerve ◽  
Dorello’S Canal ◽  
Ruptured Aneurysms ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Pica Aneurysms

OBJECTIVECompressive cranial nerve syndromes can be useful bedside clues to the diagnosis of an enlarging intracranial aneurysm and can also guide subsequent evaluation, as with an acute oculomotor nerve (cranial nerve [CN] III) palsy that is presumed to be a posterior communicating artery aneurysm and a surgical emergency until proven otherwise. The CN VI has a short cisternal segment from the pontomedullary sulcus to Dorello’s canal, remote from most PICA aneurysms but in the hemodynamic pathway of a rupturing PICA aneurysm that projects toward Dorello’s canal. The authors describe a cranial nerve syndrome for posterior inferior cerebellar artery (PICA) aneurysms that associates subarachnoid hemorrhage (SAH) and an isolated abducens nerve (CN VI) palsy.METHODSClinical and radiological data from 106 surgical patients with PICA aneurysms (66 ruptured and 40 unruptured) were retrospectively reviewed. Data from a group of 174 patients with other aneurysmal SAH (aSAH) were analyzed in a similar manner to control for nonspecific effects of SAH. Univariate statistical analysis compared incidence and risk factors associated with CN VI palsy in subarachnoid hemorrhage.RESULTSOverall, 13 (4.6%) of 280 patients had CN VI palsy at presentation, and all of them had ruptured aneurysms (representing 13 [5.4%] of the 240 cases of ruptured aneurysms). CN VI palsies were observed in 12 patients with ruptured PICA aneurysms (12/66 [18.1%]) and 1 patient with other aSAH (1/174 [0.1%], p < 0.0001). PICA aneurysm location in ruptured aneurysms was an independent predictor for CN VI palsy on multivariate analysis (p = 0.001). PICA aneurysm size was not significantly different in patients with or without CN VI palsy (average size 4.4 mm and 5.2 mm, respectively). Within the PICA aneurysm cohort, modified Fisher grade (p = 0.011) and presence of a thick cisternal SAH (modified Fisher Grades 3 and 4) (p = 0.003) were predictors of CN VI palsy. In all patients with ruptured PICA aneurysms and CN VI palsy, dome projection and presumed direction of rupture were directed toward the ipsilateral and/or contralateral Dorello’s canal, in agreement with laterality of the CN palsy. In patients with bilateral CN VI palsies, a medial projection with extensive subarachnoid blood was observed near bilateral canals.CONCLUSIONSThis study establishes a localizing connection between an isolated CN VI palsy, SAH, and an underlying ruptured PICA aneurysm. CN VI palsy is an important clinical sign in aSAH and when present on initial clinical presentation may be assumed to be due to ruptured PICA aneurysms until proven otherwise. The deficit may be ipsilateral, contralateral, or bilateral and is determined by the direction of the aneurysm dome projection and extent of subarachnoid bleeding toward Dorello’s canal, rather than by direct compression.

Cranial Nerve Compression Syndromes

Neurosurgery ◽  
2010 ◽  
pp. 475-479
Author(s):  
Jan Jakob A. Mooij
Keyword(s):  
Cranial Nerve ◽  
Nerve Compression ◽  
Nerve Compression Syndromes ◽  
Compression Syndromes

Recurrent subtemporal epidural hematoma with second, third and fourth cranial nerve compression

1984 ◽  
Vol 8 (1) ◽  
pp. 37-41
Author(s):  
Rosa E. Ramirez ◽  
Nadi Hibri ◽  
Michael W. Brennan
Keyword(s):  
Cranial Nerve ◽  
Epidural Hematoma ◽  
Nerve Compression ◽  
Fourth Cranial Nerve
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