The Supra/Infra Transtentorial Transfalcine Approach for the Removal of a Falcotentorial Meningioma: 2-Dimensional Video

2018 ◽  
Vol 16 (6) ◽  
pp. E166-E167
Author(s):  
Diego Mendez-Rosito
Keyword(s):  
External Ventricular Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Falx Cerebri ◽  
Sagittal Sinus ◽  
Adjacent Structures ◽  
Close Relationship ◽  
Dural Attachment ◽  
Neurologically Intact

Abstract Falcotentorial meningiomas originate in the junction of the falx cerebri and the tentorium. Due to its anatomic vicinity, these tumors have a close relationship with important neurovascular structures surrounding the pineal region including the deep venous system. Surgical approaches would normally consider posterior midline corridors, but decision between supra or infratentorial access should be considered by the size, anatomic displacement of structures, and the infiltration of the dural attachment. This surgical video1,2 demonstrates the surgical technique and pearls to achieve a stepwise resection of a complex falcotentorial meningioma. We present a case of a 42-yr-old female patient, neurologically intact at presentation. A semi-sitting position was used. Appropriate management of cerebrospinal fluid was obtained with an external ventricular drainage which is kept closed until the dura is opened. A suprainfratentorial craniotomy was done with adequate exposure of the superior sagittal sinus and torcula. The supracerebellar infratentorial corridor was used for inferior internal debulking and arachnoidal dissection of the tumor while the exposure obtained in the posterior interhemispheric allowed a corridor which exposed widely the tumor with transtentorial transfalcine extension. Adequate management of adjacent structures was done while preserving the straight sinus and vein of Galen. A gross total removal of the tumor was achieved and the patient was discharged without complications. After this surgical video, the viewer will have learned the steps to safely achieve a surgical removal of a falcotentorial meningioma taking care of its relationship with the venous and neural adjacent structures.

scholarly journals Combined Microscopic-Endoscopic Transmastoid Resection of a Petrous Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Emad Aboud ◽  
Ossama Al-Mefty
Keyword(s):  
Cranial Nerves ◽  
Petrous Bone ◽  
Sigmoid Sinus ◽  
Petrous Apex ◽  
Surgical Removal ◽  
Endoscopic Techniques ◽  
Petroclival Meningiomas ◽  
Close Relationship ◽  
Dural Attachment ◽  
Cerebellar Retraction

Abstract Petrous meningiomas are defined as tumors with a basal dural attachment on the posterior surface of the petrous bone.1 Their insertion can be anterior to the meatus (petrous apex meningiomas), or posterior to the meatus, with associated hyperostotic bony invasion either pre- or retro-meatal.2 These meningiomas are amenable to curative surgical removal and have better surgical outcomes than more medially located true petroclival meningiomas that originate medial to the fifth nerve.2-4 They, however, remain challenging because of their close relationship to critical neurovascular structures in the cerebellopontine angle.5 The posterior petrous meningiomas might reach a significant size with compression of the cerebellum, the brainstem, and involvement of the cranial nerves, and extend posteriorly to the transverse sigmoid sinus.2,6  Transmastoid approach with skeletonization and lateral reflection of the transverse sigmoid sinus provides a superb exposure without cerebellar retraction.6,7 The ease and complete resection of the tumor and invaded bone can be facilitated by combined microscopic-endoscopic techniques. We demonstrate these principles through the resection of a petrosal meningioma in a 56-yr-patient who presented with headaches, nystagmus, and mild cerebellar signs. The patient consented to the procedure.  Image at 1:36 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998.

scholarly journals Posterior interhemispheric transtentorial approach for resection of a meningioma at the posteromedial tentorial incisura

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Sun Liyong ◽  
Yuhai Bao ◽  
Jiantao Liang ◽  
Mingchu Li ◽  
Jian Ren
Keyword(s):  
Third Ventricle ◽  
Symptomatic Improvement ◽  
Pineal Region ◽  
Increased Intracranial Pressure ◽  
Total Removal ◽  
Adjacent Structures ◽  
Patient Reported ◽  
Surgical Corridor ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The posterior interhemispheric approach is a versatile approach to access lesions of the pineal region, posterior incisural space, posterior region of third ventricle, and adjacent structures. We demonstrate the case of a 26-year-old woman with symptoms of increased intracranial pressure and hydrocephalus caused by a meningioma at the posteromedial tentorial incisura. Gross-total removal of the tumor was successfully achieved via a posterior interhemispheric transtentorial approach. The patient reported an immediate and significant symptomatic improvement after surgery. The detailed operative technique and surgical nuances, including the surgical corridor, tentorium incision, tumor dissection and removal are illustrated in this video atlas.The video can be found here: https://youtu.be/nSNyjQKl7aE.

scholarly journals Atypical Growth Pattern of an Intraparenchymal Meningioma

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Zhen Zeng ◽  
Tijiang Zhang ◽  
Yihua Zhou ◽  
Xiaoxi Chen
Keyword(s):  
Growth Pattern ◽  
Pineal Region ◽  
Pathological Examination ◽  
Intracranial Meningioma ◽  
Temporal Region ◽  
Right Cerebral Hemisphere ◽  
Dural Attachment ◽  
The Right ◽  
Chinese Male ◽  
Irregular Mass

Meningiomas are the most common primary nonneuroglial extra-axial neoplasms, which commonly present as spherical or oval masses with a dural attachment. Meningiomas without dural attachment are rare and, according to their locations, are classified into 5 varieties, including intraventricular, deep Sylvain fissure, pineal region, intraparenchymal, or subcortical meningiomas. To the best of our knowledge, intraparenchymal meningioma with cerebriform pattern has never been reported. In this paper, we report a 34-year-old Chinese male patient who presented with paroxysmal headaches and progressive loss of vision for 10 months and blindness for 2 weeks. A thorough physical examination revealed loss of bilateral direct and indirect light reflex. No other relevant medical history and neurologic deficits were noted. Computed tomography and magnetic resonance imaging scans showed an irregular mass with a unique cerebriform pattern and extensive peritumoral edema in the parietal-occipital-temporal region of the right cerebral hemisphere. The initial diagnosis was lymphoma. Intraoperatively, the tumor was completely buried in a sulcus in the parietal-occipital-temporal region without connecting to the dura. The histological diagnosis was intracranial meningioma based on pathological examination. Therefore, when an unusual cerebriform growth pattern of a tumor is encountered, an intraparenchymal meningioma should be considered as a differential diagnosis.

MRI of pineal region tumours: relationship between tumours and adjacent structures

1995 ◽  
Vol 37 (8) ◽  
pp. 624-630 ◽  
Author(s):  
H. Satoh ◽  
T. Uozumi ◽  
K. Kiya ◽  
K. Kurisu ◽  
K. Arita ◽  
...  
Keyword(s):  
Pineal Region ◽  
Adjacent Structures ◽  
Pineal Region Tumours

Epidural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 35-44
Author(s):  
Lydia Kaoutzani ◽  
Martina Stippler
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Epidural Hematoma ◽  
Emergency Situation ◽  
Intracranial Injury ◽  
Coma Scale ◽  
Sagittal Sinus ◽  
Interosseous Artery ◽  
Neurologically Intact

Although epidural hematomas (EDH) are not frequently seen with intracranial injury in trauma, they present an emergency situation that can result in significant mortality if not diagnosed and treated in a timely manner. EDH stems from bleeding from the bone rupturing an interosseous artery, the bone itself, or from a venous sinus laceration. Most EDH present with a classic biconvex shape on CT images. Venous EDH can cross the midline and are often found under the transverse or sagittal sinus. The current school of thought is that patients who present with a small (<10 mm maximal thickness) EDH with no neurological symptoms can be treated conservatively. Patients neurologically intact with a normal Glasgow Coma Scale score but an EDH of greater than 30 cc should undergo surgery.

Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas

2020 ◽  
Vol 81 (04) ◽  
pp. 355-361
Author(s):  
Tomu Okada ◽  
Kousuke Miyahara ◽  
Shin Tanino ◽  
Kouji Suzuki ◽  
Nobuyuki Watanabe ◽  
...  
Keyword(s):  
Radical Resection ◽  
Blind Spot ◽  
Pineal Region ◽  
Anterolateral Approach ◽  
Vein Of Galen ◽  
Operating Field ◽  
Sagittal Sinus ◽  
Window Method ◽  
A Site ◽  
Turn Over

Abstract Objective Falcotentorial meningioma occurs close to the falcotentorial edges and the confluence of the vein of Galen. The posterosuperior approach conventionally used to reach this site does not allow direct visualization of the tumor matrix, making detachment difficult. Meningiomas at this location are therefore among those that are not well amenable to radical resection. We devised an alternative anterolateral approach that, when used in addition to the posterosuperior approach, provides an operating field which allows to overview large, bilaterally extending tumors. We report this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach, together with associated procedural modifications. Methods We used the approach in four patients with falcotentorial meningioma between February 2008 and July 2017. We began by extending a parieto-occipital craniotomy slightly beyond the midline, to pass across the most caudal bridging vein on the rostral side. We then created a fan-shaped fenestration as large as possible in the falx, between the superior sagittal sinus and the inferior sagittal and straight sinuses (window 1). We further performed wedge-shaped resections of both tentorial edges to the left and right of window 1 (windows 2 and 3). Tumor debulking was then carried out via these three windows (the triple-window method). Finally, we detached the tumor in the area of the falcotentorial edges and the confluence of the vein of Galen. To obtain a superorostral operating field as wide as possible from laterally, thereby exposing the potential blind spots, the operating surgeon used both hands while retracting the precuneus, and the assistant surgeon used both hands to turn over the falcotentorial edges (twosome four-hand retractorless microsurgery). Results The wide operating field provided by this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach and twosome four-hand retractorless microsurgery provides a direct view of delicate structures at the falcotentorial edges and the confluence of the vein of Galen, a site that is most likely to be a blind spot in conventional approaches. Retraction of the precuneus on the nondominant side enabled radical resection with no neurologic deficit in any of the patients. Conclusions The parieto-occipital interhemispheric transfalcine, trans-bitentorial approach with the triple-window method opens an anterolateral operating field in addition to a posterosuperior operating field in large tumors located in the falcotentorial and pineal region, extending anteroposteriorly and bilaterally. The twosome four-hand retractorless technique via this approach enables visualization of the tumor matrix at sites, which are barely visible with the conventional approach. Thus, the tumor can be removed more radically and safely.

scholarly journals Third Molar Displacement into Submandibular Space

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Mirlany Mendes Maciel Oliveira ◽  
Rodrigo da Franca Acioly ◽  
Dennis Dinelly de Souza ◽  
Bruno Araújo da Silva ◽  
Daniel Do Carmo Carvalho
Keyword(s):  
Surgical Procedure ◽  
Clinical Characteristics ◽  
Clinical Case ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Molar Tooth ◽  
Surgical Removal ◽  
Submandibular Space ◽  
Adjacent Structures

There are various accidents and complications that may occur during extraction of dental elements. The displacement of dental elements to other facial spaces is one kind of the possible complications, and there may be significant physical and psychological results for the patient. The treatment for this kind of occurrence may vary from a conservative technique to surgical procedure, what will depend on clinical characteristics, symptoms, the location of the dental element, and its relation to adjacent structures. The objective of this article is to report a clinical case of the displacement of a lower third molar tooth into the submandibular space during its extraction, followed by surgical removal through extraoral approach, with proservation for the next two years when patient evolved to paresthesia of the inferior alveolar nerve.

Meningiomas arising from the falcotentorial junction

1995 ◽  
Vol 82 (5) ◽  
pp. 726-738 ◽  
Author(s):  
Shoji Asari ◽  
Tomohide Maeshiro ◽  
Susumu Tomita ◽  
Masamitsu Kawauchi ◽  
Nobuyoshi Yabuno ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mr Imaging ◽  
Superior Sagittal Sinus ◽  
Posterior Part ◽  
Detailed Knowledge ◽  
Content Type ◽  
Sagittal Sinus ◽  
Adjacent Structures ◽  
Upward Gaze Palsy ◽  
Fine Print

✓ Meningiomas arising from the falcotentorial junction are extremely rare. The authors describe the clinical features, neuroimaging studies, and results of surgical treatment of meningiomas of the falcotentorial junction and clarify the characteristics of this lesion based on a review of the literature and seven patients treated at their institution. The most common symptoms resulted from intracranial hypertension. Upward-gaze palsy appeared in only one patient. Computerized tomography (CT) showed no specific findings, but there was no evidence of edema around the tumor. Magnetic resonance (MR) imaging revealed a round, smooth-bordered mass with a peritumoral rim, without edema, and showing marked contrast enhancement. The multiplanar capability of MR imaging delineated the relationship between the tumor and adjacent structures better than did CT. Detailed knowledge of the vascular structures, especially evidence of occlusion of the galenic venous system and the development of collateral venous channels, is critical for successful surgery; stereoscopic cerebral angiography is necessary to achieve this aim. The seven patients described developed five types of collateral venous channels: through the basal vein of Rosenthal to the petrosal vein, through the veins on the medial surface of the parietal and occipital lobes to the superior sagittal sinus, through superficial anastomotic veins, through veins of the posterior fossa to the transverse or straight sinus, and through the falcian veins to the superior sagittal sinus. The first three types mainly developed after occlusion of the galenic system. The tumors were removed through the occipital transtentorial approach with a large window at the posterior part of the falx. A favorable prognosis for patients undergoing surgical treatment of falcotentorial junction meningiomas can be expected if detailed neuroimaging studies and microsurgical techniques are used.

Sign in / Sign up

Export Citation Format

Share Document