Partial labyrinthectomy presigmoid transpetrosal resection of petroclival meningioma

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Shaun D. Rodgers ◽  
Sean O. McMenomey ◽  
Chandranath Sen
Keyword(s):  
Brain Stem ◽  
Cerebellopontine Angle ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Hearing Preservation ◽  
Petrous Bone ◽  
Line Of Sight ◽  
Petroclival Meningioma ◽  
Partial Labyrinthectomy ◽  
The Brain

A petroclival meningioma represents a challenging tumor to resect in the cerebellopontine angle and ventral to the brain stem. Multiple cranial nerves and blood vessels may be intimately involved with the tumor. A partial labyrinthectomy presigmoid transpetrosal approach can facilitate resection while preserving hearing. This approach allows for a direct line of sight along the petrous bone while sealing the canals can preserve hearing. In this video operative manuscript, we demonstrate a step-by-step illustration of a partial labyrinthectomy presigmoid transpetrosal resection of a petroclival meningioma. This approach affords the best chance of hearing preservation and an opportunity for maximum tumor resection.The video can be found here: http://youtu.be/29I4KEXz1vY.

scholarly journals Vagus Nerve Schwannoma At Cerebellopontine Angle With Extracranial Extension Through Jugular Foramen

2021 ◽  
Author(s):  
Hao Tang ◽  
Zhenghui Sun ◽  
Jiashu Zhang ◽  
Xinguang Yu
Keyword(s):  
Vagus Nerve ◽  
Brain Stem ◽  
Surgical Resection ◽  
Cerebellopontine Angle ◽  
Parapharyngeal Space ◽  
Tumor Resection ◽  
Surgical Excision ◽  
Jugular Foramen ◽  
First Choice ◽  
The Brain

Abstract Communicating tumors between the posterior fossa and parapharyngeal space are rare and difficult to diagnose and treat. Surgical excision of these space lesions is challenging because of the anatomical complexity of the area. In this case we successfully made full resection of a big rare vagus nerve schwannoma at cerebellopontine angle and parapharyngeal space. Surgical resection is the treatment of first choice for this disease. The degree of lesion adhesion to the brain stem and peripheral vessels determines the degree of tumor resection and prognosis of patients.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Suboccipital Surgical Approach to the Cerebellopontine Angle and Internal Auditory Canal

1978 ◽  
Vol 71 (4) ◽  
pp. 273-274 ◽  
Author(s):  
Mansfield F W Smith
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Prone Position ◽  
Surgical Approach ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Total Removal ◽  
Size And Shape ◽  
Suboccipital Craniectomy ◽  
The Brain

The suboccipital craniectomy done with the patient in the prone position using modern microsurgical methods gives good anatomical exposure essential for efficient, accurate, total removal of cerebellopontine angle neoplasms and allows adjacent. uninvolved neurological structures to be spared. Modifying the anatomical exposure by varying the size and shape of the osseous craniectomy and placing the dural incision closer to the porus acousticus permits extradural retraction of the cerebellum. Thus large cerebellopontine angle neoplasms can be excised with less chance of damage to the cerebellum and smaller risk of hydrocephalus. The suboccipital craniectomy may be extended anteriorly to the facial nerve, thereby combining the suboccipital with the translabyrinthine approach. and providing a more direct angle to a large neoplasm involving the brain stem and cerebellum.

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.

Nonvestibular Schwannomas of the Brain: A 7-Year Experience

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 437-449 ◽  
Author(s):  
Sajjan Sarma ◽  
Laligam N. Sekhar ◽  
David A. Schessel
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Functional Results ◽  
Senior Author ◽  
Karnofsky Performance Scale ◽  
Lumbar Drain ◽  
Scale Scores ◽  
The Brain

Abstract OBJECTIVE: Nonvestibular schwannomas are uncommon tumors of the brain. Trigeminal nerve schwannomas are the most common of this group, followed by glossopharyngeal, vagal, facial, accessory, hypoglossal, oculomotor, trochlear, and abducens nerve schwannomas, in descending order of frequency. We present a series of nonvestibular schwannomas that were surgically treated during a 7-year period. METHODS: Forty-six patients with schwannomas of Cranial Nerves V (26 cases), VII (7 cases), IX, X, and XI (9 cases), XII (3 cases), and III (1 case) were microsurgically treated by the senior author (LNS) during a 7-year period, from 1993 to 2000. The clinical presentations, operative approaches, complications, and results were studied. RESULTS: Forty-five patients underwent gross total tumor resection in the first operation. One patient who had undergone subtotal tumor resection in the initial operation experienced a large recurrence after 4 years, and gross total tumor resection was achieved in the second operation. There were no postoperative deaths. Postoperative morbidity consisted of cerebrospinal fluid leaks for 5 patients (3 patients required a second operation to repair the leak, and 2 patients responded to lumbar drain placement), meningitis for 3 patients (2 cases were aseptic and 1 involved bacterial meningitis, which resolved with antibiotic therapy), vasospasm requiring angioplasty for 1 patient, temporary hemiparesis for 2 patients (who experienced good recoveries), and permanent hemiparesis for 1 patient. New cranial nerve deficits were observed for 24% of patients but were usually partial. The mean follow-up period was 33.3 months (range, 0.2–93 mo). No patient experienced tumor recurrence after complete tumor removal. The patient who experienced regrowth of the tumor did not exhibit recurrence after the second operation. The Karnofsky Performance Scale scores at the latest follow-up examination were 80 or more for 45 patients (98%) and 70 for 1 patient. CONCLUSION: Nonvestibular schwannomas can be treated via microsurgical excision, with excellent functional results. Recurrence is rare after total tumor excision, although much longer follow-up monitoring is required.

Facial Nerve Repair in Cerebellopontine Angle Surgery

1978 ◽  
Vol 87 (6) ◽  
pp. 772-777 ◽  
Author(s):  
Derald E. Brackmann ◽  
William E. Hitselberger ◽  
Jerald V. Robinson
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Cerebellopontine Angle ◽  
Nerve Repair ◽  
Nerve Graft ◽  
Tumor Removal ◽  
Stylomastoid Foramen ◽  
Substitution Procedure ◽  
The Brain ◽  
Facial Function

Facial nerve continuity was restored during cerebellopontine angle tumor removal in nine cases. The distal facial nerve was rerouted from the stylomastoid foramen into the cerebellopontine angle. Direct suture was accomplished in seven cases while two required interposition of a greater auricular nerve graft. There was excellent return of facial function in eight of the nine cases. Overall results are superior to nerve substitution techniques. The facial nerve should be inspected for continuity following tumor removal. If one is not certain the nerve is intact, the proximal facial stump should be identified at the brain stem and facial nerve continuity reestablished. A nerve substitution procedure should be resorted to at a later time only when the proximal facial stump is not identifiable.

Brain Stem and Cranial Nerve Monitoring

2016 ◽  
pp. 788-798
Author(s):  
Brian A. Crum
Keyword(s):  
Brain Stem ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Neck Region ◽  
Accurate Identification ◽  
Nerve Monitoring ◽  
Motor Pathways ◽  
Cranial Nerve Function ◽  
The Brain ◽  
Clinical Deficits

Cranial nerves can be injured during surgical procedures performed in the middle and posterior cranial fossae as well as in the head and neck region. Damage results from compression, stretch, abrasion, or ischemia of the nerve. If axonal disruption occurs, recovery is limited, resulting in significant clinical deficits. Cranial nerve function can be monitored during anesthesia by recording spontaneous or stimulus-evoked electrical activity directly from the nerve or the cranial muscles. Activity in other pathways in the brain stem can be monitored by following changes in evoked potentials of sensory and motor pathways. These methods can detect damage to either the intra-axial or the extra-axial portion of cranial nerves and can localize cranial nerves during an operation when normal anatomy is altered, making accurate identification of nerves difficult. Finally, information from intraoperative cranial nerve monitoring may lead to an altered surgical plan to preserve neurological function.

Left-sided retrosigmoid craniotomy for the resection of a vestibular schwannoma

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Peter S. Amenta ◽  
Jacques J. Morcos
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Patient Positioning ◽  
Standard Technique ◽  
Hearing Preservation ◽  
Surgical Access ◽  
Wide Range ◽  
Primary Means

The cerebellopontine angle is the site for a wide-range of neoplastic and vascular pathologies. The retrosigmoid craniotomy remains the primary means by which to gain surgical access to this anatomically complex region. We present our standard technique for the completion of a retrosigmoid craniotomy and the resection of a left-sided vestibular schwannoma. Anatomy pertinent to the approach, including, the transverse and sigmoid sinuses, cranial nerves, and internal auditory canal (IAC) is displayed. Special emphasis is placed on patient positioning, adequate bone removal, and tumor resection. The drilling of the IAC and tumor dissection from the VII-VIII complex is also highlighted. Hearing preservation was achieved.The video can be found here: http://youtu.be/FFZju5vcBi0.

Meningiomas of the posterior petrous bone: functional outcome after microsurgery

2004 ◽  
Vol 100 (6) ◽  
pp. 1014-1024 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Mr Imaging ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Bone ◽  
Surgical Anatomy ◽  
Impaired Hearing ◽  
Imaging Data ◽  
Content Type ◽  
Hearing Function ◽  
Fine Print

Object. The aim of this study was to analyze a subgroup of patients harboring cerebellopontine angle meningiomas originating from the posterior petrous bone in regard to clinical presentation, surgical anatomy, complications, and long-term functional postoperative results. Methods. Data in a series of 51 patients with meningiomas of the posterior petrous bone who had undergone microsurgical treatment at the authors' institution between 1989 and 2002 were retrospectively reviewed. The patient population consisted of 46 women and five men with a mean age of 53 years (range 22–70 years). The main symptom on first admission was impaired hearing in 41%, dizziness in 20%, and tinnitus in 18% of the patients. Results of physical examination and audiological testing revealed hypacusis in 65% of patients, cerebellar ataxia in 31%, and impairment of the fifth cranial nerve in 26%. All patients underwent surgical treatment via a lateral suboccipital approach. Intraoperatively, the tumor was found to be attached to the postmeatal dura in 37%, the premeatal dura in 27.5%, the suprameatal dura in 19.6%, the inframeatal dura in 7.8%, and centered on the porus acusticus in 5.9% of cases. Tumor extension into the internal acoustic meatus was present in seven patients. Tumor resection was categorized as Grade I in 14 patients, Grade II in 29, Grade III in six, and Grade IV in two patients, according to the Simpson classification system. The site of displacement of the cranial nerves was predictable in up to 84% of patients, depending on the dural origin of the tumor as depicted on preoperative magnetic resonance (MR) imaging studies. Postoperatively, a new and permanent facial paresis was observed in five patients (9.8%). In 38 patients in whom both pre- and postoperative audiological data were available, hearing function deteriorated after surgery in 18.4% and improved in 7.9%. Clinical and MR imaging postsurgical data from a mean period of 5.8 years (range 13 months–13 years) were available in all patients. Forty-four patients (86%) resumed normal daily activity. Tumor recurrence was observed in two patients (3.9%), and both underwent a second surgery. Conclusions. Preoperative detailed analysis of MR imaging data gives the surgeon a clue about the dislocation of critical neurovascular structures, particularly the cranial nerves. Nonetheless, the exact relationship of the cranial nerves to the tumor (dislocation, adherence, infiltration, and splaying of nerves) can only be fully appreciated during surgery.

Primary intracranial epidermoid carcinoma

1979 ◽  
Vol 50 (6) ◽  
pp. 830-833 ◽  
Author(s):  
Yoshiki Nosaka ◽  
Seigo Nagao ◽  
Kazuo Tabuchi ◽  
Akira Nishimoto
Keyword(s):  
Brain Stem ◽  
Computerized Tomography ◽  
Cerebellopontine Angle ◽  
Epidermoid Carcinoma ◽  
Malignant Tissue ◽  
Content Type ◽  
The Right ◽  
Intracranial Epidermoid ◽  
The Brain ◽  
Fine Print

✓ A case is presented of primary intracranial epidermoid carcinoma in the right cerebellopontine angle which was visualized as a homogeneously enhanced mass on computerized tomography. At autopsy the malignant tissue was found to have invaded the brain stem.

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