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.

scholarly journals Microsurgical resection of a large cavernous malformation of the medulla oblongata

2019 ◽  
Vol 1 (1) ◽  
pp. V25
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K. Başkaya
Keyword(s):  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Foramen Magnum ◽  
Total Resection ◽  
Postoperative Course ◽  
Suboccipital Craniotomy ◽  
Postoperative Mri ◽  
Microsurgical Resection

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

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.

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.

Medulla oblongata cavernoma removal through a lazy far lateral approach: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V21
Author(s):  
Carlos Candanedo ◽  
Samuel Moscovici ◽  
Sergey Spektor
Keyword(s):  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Complete Removal ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Total Resection ◽  
Postoperative Mri ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Brainstem Cavernous Malformation

Removal of brainstem cavernous malformation remains a surgical challenge. We present a case of a 63-year-old female who was diagnosed with a large cavernoma located in the medulla oblongata. The patient suffered three episodes of brainstem bleeding resulting in significant neurological deficits (hemiparesis, dysphagia, and dysarthria). It was decided to remove the cavernoma through a left-sided modified far lateral approach.3The operative video demonstrates the surgical steps and nuances of a complete removal of this complex medulla oblongata cavernous malformation. Total resection was achieved without complications. Postoperative MRI revealed no signs of residual cavernoma with clinical improvement.The video can be found here: https://youtu.be/BTtMvvLMOFM.

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 Gross Total Resection of Large Cerebellopontine Angle Meningioma with a Supratentorial Extension via Retrosigmoid Approach with Suprameatal Drilling and Tentorial Sectioning

2018 ◽  
Vol 79 (S 05) ◽  
pp. S399-S401
Author(s):  
Sima Sayyahmelli ◽  
Adi Ahmetspahic ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Cerebellopontine Angle ◽  
Surgical Techniques ◽  
Retrosigmoid Approach ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Facial Numbness ◽  
Magnetic Resonance Imaging Mri ◽  
Health Organization

Meningiomas are the second most common neoplasm in the cerebellopontine angle (CPA), and are challenging lesions to treat surgically. With significant refinements in surgical techniques, operative morbidity, and mortality have been substantially reduced. Total or near-total surgical resection can be accomplished in the majority of cases via appropriately selected approaches, and with acceptable morbidity. In this video, we present a 51-year-old woman, who had a 2-year history of vertigo with symptoms that progressed over time. She presented with blurry vision, sensorineural hearing loss, tinnitus, left-sided facial numbness, and double vision. Magnetic resonance imaging (MRI) showed a left-sided homogeneously enhancing mass at CPA with a supratentorial extension. MRI appearance was consistent with a CPA meningioma with supratentorial extension. The patient underwent surgical resection via a retrosigmoid approach. Suprameatal drilling and tentorial sectioning were necessary to achieve gross total resection. The surgery and postoperative course were uneventful. The histopathology was a WHO (world health organization) grade I meningioma. MRI showed gross total resection of the tumor. After a 1.5-year follow-up, the patient is continuing to do well with no residual or recurrent disease. In this video, microsurgical techniques and important steps for the resection of this challenging meningioma of the cerebellopontine angle are demonstrated.The link to the video can be found at: https://youtu.be/CDto52GxrG4.

Endoscopic Resection of Hemorrhaged Third Ventricle Cavernous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E51-E51
Author(s):  
Giorgio Palandri ◽  
Thomas Sorenson ◽  
Mino Zucchelli ◽  
Nicola Acciarri ◽  
Paolo Mantovani ◽  
...  
Keyword(s):  
Gold Standard ◽  
Intraventricular Hemorrhage ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Gross Total Resection ◽  
Vascular Lesions ◽  
Total Resection ◽  
Cavernous Malformations ◽  
The Third

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.

The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection

2013 ◽  
Vol 119 (2) ◽  
pp. 475-481 ◽  
Author(s):  
Douglas A. Hardesty ◽  
Andrew B. Wolf ◽  
David G. Brachman ◽  
Heyoung L. McBride ◽  
Emad Youssef ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Recurrence Rate ◽  
Tumor Recurrence ◽  
Gross Total Resection ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Microsurgical Resection ◽  
Atypical Meningiomas

Object Patients with atypical meningioma often undergo gross-total resection (GTR) at initial presentation, but the role of adjuvant radiation therapy remains unclear. The increasing prevalence of stereotactic radiosurgery (SRS) in the modern neurosurgical era has led to the use of routine postoperative radiation therapy in the absence of evidence-based guidelines. This study sought to define the long-term recurrence rate of atypical meningiomas and identify the value of SRS in affecting outcome. Methods The authors identified 228 patients with microsurgically treated atypical meningiomas who underwent a total of 257 resections at the Barrow Neurological Institute over the last 20 years. Atypical meningiomas were diagnosed according to current WHO criteria. Clinical and radiographic data were collected retrospectively. Results Median clinical and radiographic follow-up was 52 months. Gross-total resection, defined as Simpson Grade I or II resection, was achieved in 149 patients (58%). The median proliferative index was 6.9% (range 0.4%–20.6%). Overall 51 patients (22%) demonstrated tumor recurrence at a median of 20.2 months postoperatively. Seventy-one patients (31%) underwent adjuvant radiation postoperatively, with 32 patients (14%) receiving adjuvant SRS and 39 patients (17%) receiving adjuvant intensity modulated radiation therapy (IMRT). The recurrence rate for patients receiving SRS was 25% (8/32) and for IMRT was 18% (7/39), which was not significantly different from the overall group. Gross-total resection was predictive of progression-free survival (PFS; relative risk 0.255, p < 0.0001), but postoperative SRS was not associated with improved PFS in all patients or in only those with subtotal resections. Conclusions Atypical meningiomas are increasingly irradiated, even after complete or near-complete microsurgical resection. This analysis of the largest patient series to date suggests that close observation remains reasonable in the setting of aggressive microsurgical resection. Although postoperative adjuvant SRS did not significantly affect tumor recurrence rates in this experience, a larger cohort study with longer follow-up may reveal a therapeutic benefit in the future.

Resection of a Pontine Cavernous Malformation via an Endoscopic Endonasal Approach

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE186-onsE194 ◽  
Author(s):  
Matthew M. Kimball ◽  
Stephen B. Lewis ◽  
John W. Werning ◽  
J D. Mocco
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Conservative Management ◽  
Cavernous Malformation ◽  
Gross Total Resection ◽  
Total Resection ◽  
Transnasal Approach ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation CLINICAL PRESENTATION: A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection. CONCLUSION: The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.

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