Presigmoid transpetrous approach (partial petrosectomy) combined with subtemporal transtentorial approach for petroclival meningioma

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Fernando Palacios ◽  
◽  
Manuel Lazón ◽  
Eduardo Romero ◽  
Rommel Rodriguez
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Intraoperative Complications ◽  
Brain Magnetic Resonance Imaging ◽  
Complete Resection ◽  
Neurosurgical Procedures ◽  
Resonance Imaging ◽  
Petroclival Meningioma ◽  
Skull Base Neoplasms ◽  
Petroclival Meningiomas

Introduction: Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using a combined presigmoid and subtemporal transtentorial transpetrosal approach. Clinical case: 33-year-old female patient with a clinical picture of headache, nausea, and gait disturbance. Brain magnetic resonance imaging showed a large right petroclival tumor (4.2x3.9x3.8cm) that displaced the brainstem and secondary hydrocephalus. The hydrocephalus was treated with a ventricular peritoneal shunt. Then, the tumor was resected using a combined presigmoid and subtemporal transpetrosal approach, a technique that allowed adequate exposure of the tumor, achieving complete resection, without intraoperative complications. Postoperative evolution was favorable, with no sequelae. Conclusion: The combined presigmoid and transtentorial subtemporal transpetrous approach for petroclival meningiomas is an effective and feasible technique to perform in our environment. The support of technology such as Neuronavigation, the ultrasonic aspirator, intraoperative monitoring, and adequate experience in skull base surgery are fundamental factors for the success of this surgery. Keywords: Meningioma, Skull Base Neoplasms, Craniotomy, Neurosurgical Procedures. (Source: MeSH NLM)

scholarly journals USE OF THREE-DIMENSIONAL ENDOSCOPY IN ENDONASAL AND ANTERIOR SKULL BASE SURGERY

2021 ◽  
Author(s):  
Amr Kholief ◽  
Ahmed Youseef ◽  
Ahmed Ibrahim ◽  
Samy Elwany ◽  
Shahz Ahmed
Keyword(s):  
Clinical Study ◽  
Skull Base ◽  
Surgical Procedures ◽  
Skull Base Surgery ◽  
Intraoperative Complications ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
Anatomical Landmarks ◽  
Intraoperative Complication ◽  
3D Endoscope

Objectives: The three dimensional (3D) endoscope is considered as a new surgical tool which used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of the 3D endoscopy over the two dimensional (2D) one that have been demonstrated along clinical applications, surgical training and different experimental studies. Our study aimed to show the difference between using the 3D & 2D endoscopes during endonasal and anterior skull base surgery and its importance specially when used by novice users. Design: Our study is divided into two phases (clinical & cadaveric phases).In the clinical study we have done 52 endonasal & anterior skull base surgical procedures (26 study cases and 26 control cases).We recorded accuracy, duration and intraoperative complication for each case. The cadaveric study was performed on three cadavers, difference in accuracy and dissection time were recorded using 3D & 2D endoscopy for each side chosen by randomization. Results: In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared to cases done using 2D endoscope. In cadaveric dissection while using 3D endoscope there was better depth of perception regarding the anatomical landmarks compared to 2D endoscope. Conclusion: 3D endoscopy is an advanced instrument that allows better training for the coming generation of ENT surgeons. Both clinical and cadaveric studies offer a promising outcomes in both endonasal and anterior skull base surgery.

Intraoperative Magnetic Resonance Imaging in Skull Base Surgery: A Review of 71 Consecutive Cases

2016 ◽  
Vol 93 ◽  
pp. 183-190 ◽  
Author(s):  
Ramsey Ashour ◽  
Stephen Reintjes ◽  
Michael S. Park ◽  
Sananthan Sivakanthan ◽  
Harry van Loveren ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging

scholarly journals Combined Presigmoid and Retrosigmoid Approach to Petroclival Meningiomas

2018 ◽  
Vol 79 (S 05) ◽  
pp. S402-S403
Author(s):  
Marcio Rassi ◽  
Johnni Zamponi ◽  
Duarte Cândido ◽  
Jean Oliveira ◽  
Gustavo Passos ◽  
...  
Keyword(s):  
Skull Base ◽  
Venous Drainage ◽  
Clinical History ◽  
Jugular Bulb ◽  
Retrosigmoid Approach ◽  
Limiting Factor ◽  
Posterior Aspect ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Transtentorial Approach

Introduction The management of petroclival meningiomas is among the most intimidating in neurosurgery, due to its difficult accessibility and close relationship with vital structures; therefore, an appropriate exposure is mandatory. We present a surgical video demonstrating a presigmoid transtentorial approach, associated with the opening of the retrosigmoid dura to a petroclival meningioma, performed by the senior surgeon (L.A.B.B.), along with its indications and pitfalls. Approach Decision The patient's clinical history is summed to the tumor's radiological features as its extension, vascularization, and venous drainage, when selecting the appropriate approach. The presigmoid transtentorial approach offers a wide exposure of the petroclival area along with the tumor's attachment. Its association with the retrosigmoid route allows the surgeon to freely work through multiple paths, and parallel to the skull base, reducing the traction in the temporal lobe. Clinical Case This is a 39-year-old female presenting with trigeminal neuralgia. Imaging depicted a petroclival meningioma, extending from the posterior aspect of the cavernous sinus to the cerebellopontine angle, extending inferiorly to the jugular bulb. A Simpson II resection was achieved through a combined presigmoid and retrosigmoid approach, and the patient was discharged with no complications or new deficits. Conclusion Petroclival meningiomas are a formidable and surgically treatable disease. The appropriate approach is design to each patient and should not be the limiting factor for total tumor removal, which is truly given by the absence of a dissection plane between the tumor and the brainstem, nerves and vascular structures of the skull base.The link to the video can be found at: https://youtu.be/MFjqZvElBSo.

Lateral Transzygomatic Approach to Sphenoid Wing Meningiomas

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons377-ons384 ◽  
Author(s):  
Claude-Jean Langevin ◽  
Matthew M. Hanasono ◽  
Howard A. Riina ◽  
Philip E. Stieg ◽  
Henry M. Spinelli
Keyword(s):  
Skull Base ◽  
Masseter Muscle ◽  
Early Stage ◽  
Complete Removal ◽  
Complete Resection ◽  
Minimal Morbidity ◽  
Skull Base Neoplasms ◽  
Lateral Skull Base ◽  
Brain Retraction ◽  
Sphenoid Wing Meningioma

ABSTRACT BACKGROUND: Sphenoid wing meningiomas are slow-growing, well-circumscribed, and histologically benign lesions. The recurrence rate is low if removed completely at the time of surgery. Adequate surgical exposure with minimal morbidity is a challenge for those treating these lateral skull base lesions. OBJECTIVE: To describe our experience with the lateral tranzygomatic approach for resection of sphenoid wing meningioms in which the entire zygoma is mobilized and remains vascularized by masseter muscle attachments. METHODS: A retrospective review of the records of 19 patients who underwent sphenoid wing meningioma resection via a lateral transzygomatic approach between 1997 and 2007 was performed. A confirmatory cadaver dissection was performed to illustrate the anatomic nature of the technique. To achieve maximal exposure and minimal brain retraction, a lateral transzygomatic approach with osteotomies of the entire zygoma, which remains pedicled on the masseter muscle, was used. RESULTS: Nineteen patients with sphenoid wing meningioma underwent resection via a lateral transzygomatic approach. Complete resection of the meningioma was achieved in 17 cases. Morbidity consisted of temporary frontal nerve weakness (57.9%), mild to moderate temporalis atrophy (36.8%), and diplopia (15.8%). There were no cases of wound infection, bone malunion, or resorption. A mean follow-up period of 33.1 months (range, 2-71 months) revealed no recurrences after surgery as demonstrated by computed tomography or magnetic resonance imaging. CONCLUSION: The lateral transzygomatic approach to the sphenoid wing can be performed safely with minimal morbidity and facilitates complete resection of the tumor. Complete removal at an early stage is the best prognostic factor in treating sphenoid wing meningioma. This approach belongs in the armamentarium of surgeons who are involved in the resection of skull base neoplasms.

scholarly journals Combined Petrosal Approach for Resection of Petroclival Meningioma with Endoscopic Assistance: Operative Video and Technical Nuances

2019 ◽  
Vol 80 (S 03) ◽  
pp. S292-S293
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Skull Base ◽  
Petrous Bone ◽  
Dural Defect ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Hearing Function ◽  
Endoscopic Assistance ◽  
Anterior Petrosectomy ◽  
Microsurgical Resection ◽  
Neurovascular Structures

Petroclival meningiomas are formidable lesions due to their deep location in the skull base and proximity to critical neurovascular structures. The combined petrosal approach, comprised of an anterior petrosectomy and posterior retrolabyrinthine petrosectomy, allows for both supra- and infratentorial exposure of the tumor in the petroclival region while potentially preserving hearing function (Fig. 1). In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petroclival meningioma via the combined petrosal approach. The nuances of microsurgical and skull base technique are illustrated including drilling of the petrous bone, transecting the tentorium, resection of the tumor, and multilayered reconstruction of the dural defect. The combined petrosal approach allows for multiple angles of attack including both subtemporal and presigmoid corridors. In summary, the combined petrosal approach with endoscopic assistance is an important strategy in the armamentarium for surgical resection of petroclival meningiomas (Fig. 2).The link to the video can be found at: https://youtu.be/ipZb9kHcP2g.

scholarly journals Role of Skull Base Surgery for Cavernous Sinus and/or Petroclival Meningiomas(Skull Base Surgery in the Radiosurgery Era)

2011 ◽  
Vol 20 (3) ◽  
pp. 170-176
Author(s):  
Kiyoshi Saito ◽  
Eiji Ito ◽  
Taku Sato ◽  
Masahiro Ichikawa ◽  
Tadashi Watanabe ◽  
...  
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Skull Base Surgery ◽  
Special Issue ◽  
Petroclival Meningiomas
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