scholarly journals The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas

2016 ◽  
Vol 74 (5) ◽  
pp. 382-387 ◽  
Author(s):  
Jose Carlos Lynch ◽  
Mariangela Barbi Gonçalves ◽  
Celestino Esteves Pereira ◽  
Wladimir Melo ◽  
Gianni Ferraz Temponi
Keyword(s):  
Anterior Cranial Fossa ◽  
Surgical Mortality ◽  
Imaging Studies ◽  
Total Removal ◽  
Pterional Approach ◽  
Total Resection ◽  
Operative Strategy ◽  
Cranial Fossa ◽  
Tuberculum Sellae

ABSTRACT Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.

scholarly journals Extended Pterional Approach for Medial Sphenoid Wing Meningioma: A Series of 47 Patients

2019 ◽  
Vol 81 (02) ◽  
pp. 107-113
Author(s):  
Jose Carlos Lynch ◽  
Celestino Esteves Pereira ◽  
Mariangela Gonçalves ◽  
Nelci Zanon
Keyword(s):  
Gross Total Resection ◽  
Surgical Mortality ◽  
Median Length ◽  
Pterional Approach ◽  
Total Resection ◽  
Operative Strategy ◽  
Imaging Results ◽  
Sphenoid Wing Meningioma

Abstract Background To describe our operative strategy and analyze its safety and effectiveness for the removal of medial sphenoid wing meningiomas (MSWMs) through the extended pterional approach. Method We identified 47 patients with MSWMs who were operated using this approach between 1986 and 2016. Medical charts, operative reports, imaging results, and clinical follow-up evaluations were reviewed and retrospectively analyzed. Results No surgical mortality was observed in this sample. Gross total resection was achieved in 30 (63.8%) patients. Intradural clinoidectomy was performed in 16 (34%) patients. The median length of follow-up was 8.5 years (range, 1–30 years). Conclusion The extended pterional approach associated with microsurgery techniques provided excellent results for the removal of MSWMs.

scholarly journals Tuberculum Sellae Meningiomas: Outcome of Twenty-eight Cases after Surgery

2020 ◽  
Vol 10 (1) ◽  
pp. 39-44
Author(s):  
Md Atikur Rahman ◽  
Nwoshin Jahan ◽  
Mohammad Shahnawaz Bari ◽  
Pijush Kanti Mitra ◽  
Ahsan Mohammad Hafiz ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Tumour Size ◽  
Pterional Approach ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Postoperative Visual Acuity ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale ◽  
Negative Predictor

Objective: To present this series of surgically treated tuberculum sellae meningiomas with particular regard to visual compromises Methods: A retrospective analysis was done on 28 patients (21 females) with meningiomas originating from the tuberculum sellae who underwent surgery between 2010 and 2019. The standard surgical approach of pterional craniotomy. Twelve meningiomas extended posteriorly onto the diaphragma sellae, 13 anteriorly to the planum sphenoidale, and 3 to the anterior clinoid process. 21 tumours involved the optic canal, one bilaterally. Follow up ranged from 6 to 12 months. Results: Total microscopic resection was achieved in 28 patients. Median tumour size was 3.2 cm. Postoperatively, visual acuity improved in 19 patients and deteriorated 3. Preoperative and postoperative visual acuity worsened with increasing duration of preoperative symptoms and with increasing age. Extension into the intraconal space was a negative predictor. Recurrence occurred in one cases. One patients died from causes unrelated to the tumour. Conclusions: In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications. Bang. J Neurosurgery 2020; 10(1): 39-44

scholarly journals Microsurgical ressection for parasagittal meningiomas with preservation of the parasagittal sinus and excelent neurovascular control

2013 ◽  
Vol 71 (5) ◽  
pp. 301-306 ◽  
Author(s):  
José Carlos Lynch ◽  
Hugo Schiavini ◽  
Cleber Bomfim ◽  
Joelton Fernandes Fonseca ◽  
Celestino Pereira
Keyword(s):  
Mortality Rate ◽  
Surgical Approach ◽  
Great Majority ◽  
Surgical Mortality ◽  
Imaging Studies ◽  
Total Removal ◽  
Parasagittal Meningioma

Objective:It was to observe whether a microsurgical gross total removal (GTR) of a parasagittal meningioma (PSM) outside the sinus is a safe and efficient procedure.Method:We identify 58 parasagittal meningiomas patients. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed.Results:GTR of the mass was achieved in 45 (77.7%) instances. The surgical mortality rate was 1.7%. The median follow-up time was 63 months.Conclusion:The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality, proving to be safe and effective.

scholarly journals Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients

2014 ◽  
Vol 72 (4) ◽  
pp. 312-317 ◽  
Author(s):  
Rudi Lenck Fernandes ◽  
José Carlos Lynch ◽  
Leonardo Welling ◽  
Mariangela Gonçalves ◽  
Rodrigo Tragante ◽  
...  
Keyword(s):  
Great Majority ◽  
Complete Removal ◽  
Spinal Nerve ◽  
Surgical Mortality ◽  
Total Removal ◽  
Recurrence Rates ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Recurrence Method

Objective: Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. Method: We identify 30 patients with 44 SNSTs. Results: We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. Conclusion: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective.

Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy

1989 ◽  
Vol 70 (4) ◽  
pp. 525-529 ◽  
Author(s):  
Chad D. Abernathey ◽  
Dudley H. Davis ◽  
Patrick J. Kelly
Keyword(s):  
Third Ventricle ◽  
Total Removal ◽  
Total Resection ◽  
Content Type ◽  
The Third ◽  
Cyst Aspiration ◽  
Colloid Cysts ◽  
Mass Lesions ◽  
Fine Print

✓ The therapeutic strategies employed in the management of anterior third-ventricular mass lesions remain controversial. Resection by conventional craniotomy, whether via a transcallosal or transcortical approach, carries well-known risks and limitations. Alternatively, in this region traditional stereotaxy has been relegated to use with biopsy only or cyst aspiration procedures. Combining aspects of both conventional and stereotaxic techniques has allowed total removal of 12 colloid cysts in six women and six men ranging in age from 25 to 71 years. No mortality and minimal morbidity have been associated with the procedures. There has been no evidence of recurrence in an average follow-up period of 19 months. By coupling the benefits of stereotaxic precision and localization to the microsurgical management of colloid cysts, several rewards have been realized: 1) only a limited cortical dissection is needed; 2) the hazards of callosal or forniceal injury can be avoided; 3) the lesion is easily localized regardless of ventricular size; 4) hemostasis can be readily achieved with bipolar cautery or defocused laser power; and 5) most importantly, a total resection is possible with little risk to the patient. Stereotaxic microsurgical laser craniotomy provides a new option for the management of colloid cysts and other anterior third-ventricular lesions.

scholarly journals Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

2019 ◽  
Vol 81 (06) ◽  
pp. 686-693
Author(s):  
Haiyong He ◽  
Meiqin Cai ◽  
Manting Li ◽  
Lei Wei ◽  
Lun Luo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Modified Rankin Scale ◽  
Pterional Approach ◽  
Total Resection ◽  
Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

scholarly journals Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx

2008 ◽  
Vol 14 (4) ◽  
pp. 415-427 ◽  
Author(s):  
Xianli Lv ◽  
Chuhan Jiang ◽  
Youxiang Li ◽  
Xinjian Yang ◽  
Zhongxue Wu
Keyword(s):  
Cavernous Sinus ◽  
Clinical Results ◽  
Sigmoid Sinus ◽  
Anterior Cranial Fossa ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Detachable Coils ◽  
Cranial Fossa ◽  
Age Range

This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization. Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11–70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome. Data for 23 patients (age range, 11–70 yrs, mean age 49.5 yrs) with DAVFs (cavernous sinus[CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment. The mean clinical follow-up period was 22.1 months. Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs.

Mini-Pterional Approach to Anterior Cranial Fossa Meningiomas

2016 ◽  
pp. 223-235 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Nicolas O. Koechlin ◽  
Hazem J. Abuhusain ◽  
Charles Teo
Keyword(s):  
Anterior Cranial Fossa ◽  
Pterional Approach ◽  
Cranial Fossa

scholarly journals Extended Retrosigmoid Approach for Cerebellopontine Angle Meningiomas: Operative Technique and Results—A Series of 28 Patients

2018 ◽  
Vol 79 (05) ◽  
pp. 458-465 ◽  
Author(s):  
Celestino Pereira ◽  
Leonardo Welling ◽  
Mariangela Gonçalves ◽  
Nelci Zanon ◽  
Jose Lynch
Keyword(s):  
Operative Technique ◽  
Cerebellopontine Angle ◽  
Cranial Base ◽  
Sigmoid Sinus ◽  
Retrosigmoid Approach ◽  
Surgical Mortality ◽  
Total Removal ◽  
Surgical Strategies ◽  
The Mean

Background The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). Methods We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. Results The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). Conclusion The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cranial base approaches.

Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment

2009 ◽  
Vol 110 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Ronit Agid ◽  
Karel TerBrugge ◽  
Georges Rodesch ◽  
Tommy Andersson ◽  
Michael Söderman
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Procedures ◽  
Treated Patient ◽  
Management Strategies ◽  
Anterior Cranial Fossa ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Open Surgical Treatment

Object Dural arteriovenous fistulas (DAVFs) of the anterior cranial fossa are rare lesions that can cause intracranial hemorrhage. Authors of previous reports mostly have described open surgical treatment for this fistula type. The authors' purpose in the present study was to describe their experience with anterior cranial fossa DAVFs, including their endovascular treatment. Methods All patients with anterior cranial fossa DAVFs diagnosed and treated in 3 separate institutions during the last 23 years were retrospectively identified. Clinical charts, imaging studies, and procedural notes were evaluated. Results Twenty-four patients (22 males and 2 females), ranging in age from 3 to 77 years, harbored 24 DAVFs in the anterior cranial fossa. Eleven patients were primarily treated with surgical disconnection and 2 with radiosurgery. Eleven patients were treated endovascularly; 7 of these patients (63.6%) were cured. In 4 cases of failed embolization, final disconnection was achieved through surgery. In fact, surgery was effective in disconnecting the fistula in 100% of cases. All endovascular procedures consisted of transarterial injections of diluted glue (N-butyl cyanoacrylate [NBCA]), and there were no complications. Brain edema developed around the venous pouch and confusion was apparent after venous disconnection in 1 surgically treated patient. No patient suffered a hemorrhage during the follow-up period. Conclusions Disconnection of an anterior cranial fossa DAVF by using transarterial catheterization through the ophthalmic artery and subsequent injection of NBCA is possible with a reasonable success rate and low risk for complications. In patients with good vascular access this procedure could be the treatment of choice, to be followed by open surgery in cases of embolization failure.

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