scholarly journals Case Report: A Case Series Using Natural Anatomical Gaps—Posterior Cervical Approach to Skull Base and Upper Craniocervical Meningiomas Without Bone Removal

2021 ◽  
Vol 8 ◽  
Author(s):  
Nadine Lilla ◽  
Almuth F. Kessler ◽  
Judith Weiland ◽  
Ralf-Ingo Ernestus ◽  
Thomas Westermaier
Keyword(s):  
Minimally Invasive ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
X Rays ◽  
Mass Reduction ◽  
Invasive Approach ◽  
Tumor Capsule ◽  
Upper Cervical ◽  
Lower Clivus ◽  
Tumor Consistency

Background: Removal of anteriorly located tumors of the upper cervical spine and craniovertebral junction (CVJ) is a particular surgical challenge. Extensive approaches are associated with pain, restricted mobility of neck and head and, in case of foramen magnum and clivus tumors, with retraction of brainstem and cerebellum.Methods: Four symptomatic patients underwent resection of anteriorly located upper cervical and lower clivus meningiomas without laminotomy or craniotomy using a minimally invasive posterior approach. Distances of natural gaps between C0/C1, C1/C2, and C2/C3 were measured using preoperative CT scans and intraoperative lateral x-rays.Results: In all patients, safe and complete resection was conducted by the opening of the dura between C0/C1, C1/C2, and C2/C3, respectively. There were no surgical complications. Local pain was reported as very moderate by all patients and postoperative recovery was extremely fast. All tumors had a rather soft consistency, allowing mass reduction prior to removal of the tumor capsule and were well separable from lower cranial nerves and vascular structures.Conclusion: If tumor consistency is appropriate for careful mass reduction before removal of the tumor capsule and if tumor margins are not firmly attached to crucial structures, then upper cervical, foramen magnum, and lower clivus meningiomas can be safely and completely removed through natural gaps in the CVJ region. Both prerequisites usually become clear early during surgery. Thus, this tumor entity may be planned using this minimally invasive approach and may be extended if tumor consistency turns out to be less unfavorable for resection or if crucial structures cannot be easily separated from the tumor.

scholarly journals Transoral needle procedures for upper cervical spine and clival lesions: technical note and indications

2010 ◽  
Vol 29 (04) ◽  
pp. 126-129
Author(s):  
Horacio Armando Marenco ◽  
Andrei Fernandes Joaquim ◽  
João Flávio Daniel Zullo ◽  
Marcelo Luis Mudo
Keyword(s):  
Cervical Spine ◽  
Minimally Invasive ◽  
Needle Biopsy ◽  
Diagnostic Procedures ◽  
Technical Note ◽  
Upper Cervical Spine ◽  
Minimally Invasive Techniques ◽  
Upper Cervical ◽  
Lower Clivus ◽  
Invasive Techniques

AbstractTransoral needle procedures are minimally invasive techniques derived from the transoral (or transoropharyngeal) approach to the upper cervical spine and clival region. They are indicated for diagnostic procedures and vertebroplasty. These techniques are appropriated to access midline pathologies from the lower clivus to the C2-C3 disk. This article describes in a step by step manner, the technique and indications for needle biopsy and vertebroplasty in this region, discussing technical nuances.

Minimally Invasive Surgical Treatment of Bertolotti's Syndrome: Case Report

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS454-ONS455 ◽  
Author(s):  
Kene T. Ugokwe ◽  
Tsu-Lee Chen ◽  
Eric Klineberg ◽  
Michael P. Steinmetz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Low Back ◽  
X Rays ◽  
Invasive Approach

Abstract Objective: This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. Methods: In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation. Results: The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery. Conclusion: As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.

scholarly journals C1 Hemilaminectomy for Resection of Foramen Magnum Meningioma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Stefan Lieber ◽  
Rocio Evangelista-Zamora ◽  
Maximiliano Nunez ◽  
Marcos Tatagiba
Keyword(s):  
Cranial Nerves ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
World Health ◽  
Proliferation Index ◽  
Tectorial Membrane ◽  
Who Grade ◽  
Invasive Approach ◽  
Health Organization ◽  
Lower Clivus

AbstractWe present a case of a sizeable foramen magnum meningioma that was resected through a C1 hemilaminectomy in prone (concorde) position. The patient is a 51-year-old woman with a 3-month history of progressive paresthesia of the upper and lower extremities, followed by gait disturbance, and hand apraxia. There was no complaint of nuchal pain.On magnetic resonance imaging (MRI) a briskly enhancing extra-axial, intradural craniospinal lesion, extending from the basion of the lower clivus, over the tectorial membrane to the middle of the axis' body was discovered. There was significant transposition and compression of the medulla and corresponding focal hyperintensity on T2-weighted imaging.On physical examination, the patient was ambulatory independently, notwithstanding a pronounced spinal ataxia. There were deficits in sensation and proprioception, as well as urinary retention, but preserved function of the lower cranial nerves.In view of the profound transposition of the medulla, utilization of the corridor created by the tumor seemed feasible and we felt that a limited C1 hemilaminectomy would provide sufficient microsurgical access thus obviating a more extensive and invasive approach to the craniocervical junction.A gross-total resection was achieved; histopathology confirmed a World Health Organization (WHO) grade I angiomatous meningioma with a low-proliferation index. The patient was discharged home 3 days after surgery and her spinal ataxia resolved completely within 3 months of out-patient rehabilitation. At 3-year follow-up, there was no indication of residual or recurrence.The link to the video can be found at: https://youtu.be/WyShbfr-xi0.

Minimally invasive approach for small ventrally located intradural lesions of the craniovertebral junction

2015 ◽  
Vol 38 (4) ◽  
pp. E10 ◽  
Author(s):  
Sven O. Eicker ◽  
Klaus Christian Mende ◽  
Lasse Dührsen ◽  
Nils Ole Schmidt
Keyword(s):  
Minimally Invasive ◽  
Medical Center ◽  
Craniovertebral Junction ◽  
Upper Cervical Spine ◽  
Small Lesion ◽  
Neutral Position ◽  
Dorsal Approach ◽  
Who Grade ◽  
Invasive Approach ◽  
Minimally Invasive Surgical

OBJECT The surgical management of lesions ventral to the neuraxis at the level of the craniovertebral junction (CVJ) and upper cervical spine is challenging. Here, the authors describe a minimally invasive dorsal approach for small ventrally located intradural lesions at the CVJ as an alternative for the more extensive classic transoral approach or variants of suboccipital approaches. METHODS Between 2012 and 2014, 6 symptomatic patients with a small lesion of the ventral aspect at the CVJ level were treated using a minimally invasive dorsal approach at the University Medical Center in Hamburg-Eppendorf, Germany. The anatomical distance between the posterior atlantooccipital membrane and the posterior atlantoaxial ligament, as determined by CT images, was assessed in the treated patients and in 100 untreated persons. RESULTS The authors treated 6 patients (mean age 54.7 years) who had a clinical presentation of mild neurological symptoms that disappeared after resection. Minimally invasive surgical dorsal access was achieved by using tubular systems and using the natural space between the occiput (C-0) and C-1, and in 1 case between C-1 and C-2, without having to remove bony structures. The postoperative course in each of the 6 patients was uneventful. The neuropatho-logical findings confirmed a meningotheliomatous meningioma (WHO Grade I) in 5 cases and an extramedullary cavernous hemangioma in 1 case. MRI confirmed complete resection of all the lesions. The atlantooccipital distances ranged from 3 to 17 mm (mean 8.98 mm) in the supine neutral position, and the atlantoaxial distances ranged from 5 to 17 mm (mean 10.56 mm). There were no significant differences between women and men (atlantooccipital p = 0.14; atlantoaxial p = 0.72). CONCLUSIONS The results of this study demonstrate that the minimally invasive dorsal approach using the space between C-0 and C-1 or C-1 and C-2 provides direct and sufficient exposure for the safe surgical resection of small ventrally located intradural lesions at the CVJ level while reducing the necessity for musculoskeletal preparation to a minimum.

Extreme lateral transcondylar approach for resection of ventrally based meningioma of the craniovertebral junction and upper cervical spine

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
James K. Liu
Keyword(s):  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Close Association ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Transcondylar Approach ◽  
Intradural Tumor ◽  
Upper Cervical ◽  
Microsurgical Resection

Ventrally based meningiomas at the craniovertebral junction can be challenging tumors to remove because of their deep location anterior to the lower brainstem and upper cervical spinal cord, and close association with complex neurovascular structures. The extreme lateral transcondylar approach provides excellent access and exposure to anterior and anterolateral intradural tumors involving the region of the craniovertebral junction, including the lower third of the clivus, the foramen magnum, and the upper cervical spine. This approach allows safe access for removal of these difficult tumors without any neural retraction. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a ventrally based meningioma extending from the foramen magnum to C-2 using the extreme lateral transcondylar approach. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and cranial base reconstruction, are illustrated in this video atlas. The video can be found here: http://youtu.be/4uvPpEtEShU.

Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

Posterolateral Approaches to the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A135-A140 ◽  
Author(s):  
Youssef R. Karam ◽  
Arnold H. Menezes ◽  
Vincent C. Traynelis
Keyword(s):  
Effective Means ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Posterolateral Approach ◽  
Upper Cervical Spine ◽  
Dural Closure ◽  
Far Lateral Approach ◽  
Upper Cervical ◽  
The Stability

Abstract OBJECTIVE The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. METHODS The literature addressing posterolateral approaches to the CVJ is reviewed, and illustrative cases are presented. RESULTS The far lateral approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are an effective means of addressing intradural anterior and anterolateral CVJ lesions. These approaches provide exposure of the lower third of the clivus, the foramen magnum, and the upper cervical spine; do not cross contaminated regions; and enable a watertight dural closure to be performed. They are associated with minimal morbidity and usually do not significantly decrease the stability of the CVJ. CONCLUSION All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.

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