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da Silveira RL, Von Zuben DDO, Bertani R, Landeiro JA. Foramen magnum meningioma approached by the midline subtonsilar approach - Revisiting Cushing's classification of craniospinal meningiomas. Surg Neurol Int 2023; 14:56. [PMID: 36895217 PMCID: PMC9990808 DOI: 10.25259/sni_939_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Background The management of foramen magnum meningiomas (FMMs) has been a challenge for skull base neurosurgeons. Since the initial description of a FMM in 1872, various surgical approaches have been described. Posterior and posterolateral FMMs are safely removed through a standard midline suboccipital approach. Nevertheless, we still face controversy regarding the management of anterior or anterolateral lesions. Case Description A 47-year-old patient presented with progressive headaches, unsteadiness, and tremor. Magnetic resonance imaging showed an FMM that caused significant displacement of the brainstem. Conclusion This operative video highlights a safe and effective surgical technique for the resection of an anterior foramen magnum meningioma.
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Affiliation(s)
| | | | - Raphael Bertani
- Department of Vascular and Skull Base, University of Sao Paulo, São Paulo, Brazil
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SHIBAO S, YOSHIDA K, SOGANO J, MIZUTANI K, TOMITA H. Meningiomas Involving the Hypoglossal Canal: A Case Report and Literature Review. NMC Case Rep J 2022; 9:171-176. [PMID: 35855282 PMCID: PMC9256018 DOI: 10.2176/jns-nmc.2021-0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of hypoglossal canal meningioma in a 65-year-old woman who presented with dysphagia. Neurological examination revealed left hypoglossal nerve palsy. Head computed tomography and magnetic resonance imaging revealed a lesion around the left hypoglossal canal. She underwent a total resection with a midline suboccipital transcondylar approach. There were no postoperative complications, and the hypoglossal nerve palsy improved. There was no recurrence nine months after the surgery. Choosing a surgical approach that considers the site of origin and extent of tumor extension is important.
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Affiliation(s)
| | | | - Junki SOGANO
- Department of Neurosurgery, Ashikaga Red Cross Hospital
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Wang M, Chae R, Shehata J, Vigo V, Raygor KP, Tomasi SO, McDermott MW, Abla AA, El-Sayed IH, Rodriguez Rubio R. Comparative analysis of surgical exposure and freedom between the subtonsillar, endoscope-assisted subtonsillar, and far-lateral approaches to the lower clivus: A cadaveric study. J Clin Neurosci 2020; 72:412-419. [PMID: 31937496 DOI: 10.1016/j.jocn.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/12/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
The far-lateral (FL)approach is a classic technique for skull base surgeries involving the lower clivus (LC).Recently, a modified suboccipital midline approach known as the subtonsillar (ST) approach, along with the endoscope-assisted subtonsillar (EST) approach, has been described as a minimally invasive technique to treat LC lesions. However, there is no quantitative study on comparing these approaches together for reaching LC. We aimed to compare surgical exposure and freedom provided by ST, EST, and FL approaches for various targets at LC. These approaches were performed on each side of five cadaveric specimens (total 10 sides), and relevant parameters were quantified and compared using a repeated measures ANOVA test. FL approach yielded the greatest surgical area (237.8 ± 56.0 mm2) and exposure, including lengths of glossopharyngeal nerve (16.2 ± 1.9 mm), hypoglossal nerve (11.4 ± 2.4 mm), vertebral artery (23.9 ± 3.3 mm), followed by EST and ST approaches. For surgical freedom, FL approach provided the greatest angle of attack (90.0 ± 14.0° at jugular foramen, 95.1 ± 15.8° at hypoglossal canal, 83.4 ± 31.4° at bifurcation point of posterior inferior cerebellar artery and vertebral artery). Our systematic comparison suggests that EST approach, compared to ST approach, can significantly increase surgical exposure to the medial side of LC, but FL approach still provides the greatest surgical exposure and freedom at LC. Despite the limitations of a cadaveric study, our quantitative data can update the literature on currently available surgical techniques for reaching LC and better inform preoperative planning in this area. Further studies should be performed to evaluate these approaches in clinical practice.
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Affiliation(s)
- Minghao Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA
| | - Ricky Chae
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Joseph Shehata
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Vera Vigo
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Kunal P Raygor
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Santino Ottavio Tomasi
- Department of Neurosurgery, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael W McDermott
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Adib A Abla
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Ivan H El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Roberto Rodriguez Rubio
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA; Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA. http://skullbaselab.ucsf.edu
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