1
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Tang K, Bu B, Tian H, Li Y, Jiang X, Qian Z, Zhou Y. Automated algorithm aided capacity and confidence boost in surgical decision-making training for inferior clivus. Front Surg 2024; 11:1375861. [PMID: 38699561 PMCID: PMC11063266 DOI: 10.3389/fsurg.2024.1375861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objective To assess the impact of automated algorithms on the trainees' decision-making capacity and confidence for individualized surgical planning. Methods At Chinese PLA General Hospital, trainees were enrolled to undergo decision-making capacity and confidence training through three alternative visual tasks of the inferior clivus model formed from an automated algorithm and given consecutively in three exemplars. The rationale of automated decision-making was used to instruct each trainee. Results Following automated decision-making calculation in 50 skull base models, we screened out three optimal plans, infra-tubercle approach (ITA), trans-tubercle approach (TTA), and supra-tubercle approach (STA) for 41 (82.00%), 8 (16.00%), and 1 (2.00%) subject, respectively. From September 1, 2023, through November 17, 2023, 62 trainees (median age [range]: 27 [26-28]; 28 [45.16%] female; 25 [40.32%] neurosurgeons) made a decision among the three plans for the three typical models (ITA, TTA, and STA exemplars). The confidence ratings had fine test-retest reliability (Spearman's rho: 0.979; 95% CI: 0.970 to 0.988) and criterion validity with time spent (Spearman's rho: -0.954; 95%CI: -0.963 to -0.945). Following instruction of automated decision-making, time spent (initial test: 24.02 vs. 7.13 in ITA; 30.24 vs. 7.06 in TTA; 34.21 vs. 12.82 in STA) and total hits (initial test: 30 vs. 16 in ITA; 37 vs. 17 in TTA; 42 vs. 28 in STA) reduced significantly; confidence ratings (initial test: 2 vs. 4 in ITA; 2 vs. 4 in TTA; 1 vs. 3 in STA) increased correspondingly. Statistically significant differences (P < 0.05) were observed for the above comparisons. Conclusions The education tool generated by automated decision-making considers surgical freedom and injury risk for the individualized risk-benefit assessment, which may provide explicit information to increase trainees' decision-making capacity and confidence.
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Affiliation(s)
- Ke Tang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Bo Bu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Hongcheng Tian
- Department of Information, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Yang Li
- Department of Oral and Maxillofacial Surgery, Peking University Hospital of Stomatology, Beijing, China
| | - Xingwang Jiang
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiqiang Zhou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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2
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Abdala-Vargas NJ, Palmisciano P, Baldoncini M, Villalonga JF, Campero Á. Three-Stage Surgical Resection in Semisitting Position of Sphenocavernopetroclival-Foramen Magnum Meningioma: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01120. [PMID: 38624202 DOI: 10.1227/ons.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024] Open
Abstract
Large meningiomas extending through the middle cranial fossa, posterior fossa, and foramen magnum (FM) represent a surgical challenge even for experienced skull base surgeons.1 Although decompression may be necessary for offering clinical improvement, surgical risks may involve cranial nerves and vascular injury. We present a case of a sphenocavernopetroclival-FM meningioma, with our surgical plan extending through the sphenoid region, FM, and posterior fossa to the anterior arch of C1. We designed a 2-day, 3-stage surgical strategy to achieve complete surgical resection for offering better long-term prognosis and satisfactory postoperative neurological outcome.2 The surgical plan was completed in 2 days of surgery: the first day the extradural part for achieving optimal tumor exposure and the second day the intradural part to tackle tumor resection in a 3-stage fashion. The first stage consisted in a far lateral approach to access the lower portion of the tumor extending from the FM to the spinal region; the second stage focused on the portion of the tumor extending through the inferior clivus and the petroclival region; and the third stage consisted in resecting the tumor extending from the petroclival region to the sphenoid region.3 A near-total resection was achieved, with a very small tumor remnant observed at the level of the tentorium on postoperative MRI, which was treated with radiosurgery owing to the young age of the patient. This is a 3-dimensional operative video showing the surgical steps of the tumor resection. The patient consented to the procedure and to the publication of her image.
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Affiliation(s)
- Nadin J Abdala-Vargas
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Paolo Palmisciano
- Department of Neurosurgery, UC Davis Medical Center, Sacramento, California, USA
| | - Matías Baldoncini
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Juan F Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Departamento de Neurocirugía, Hospital Ángel C. Padilla, Tucumán, Argentina
| | - Álvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Departamento de Neurocirugía, Hospital Ángel C. Padilla, Tucumán, Argentina
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3
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Graffeo CS, Perry A, Carlstrom LP, Leonel L, Nguyen BT, Morris JM, Driscoll CLW, Link MJ, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Far Lateral Approach. J Neurol Surg B Skull Base 2023; 84:170-182. [PMID: 36895809 PMCID: PMC9991529 DOI: 10.1055/a-1760-2528] [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: 11/15/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
Introduction Skull base neuroanatomy is classically taught using surgical atlases. Although these texts are critical and rich resources for learning three-dimensional (3D) relationships between key structures, we believe they could be optimized and complemented with step-by-step anatomical dissections to fully meet the learning needs of trainees. Methods Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A far lateral craniotomy was performed by each of three neurosurgery resident/fellow at varying stages of training. The study objective was the completion and photodocumentation of the craniotomy to accompany a stepwise description of the exposure to provide a comprehensive, intelligible, and anatomically oriented resource for trainees at any level. Illustrative case examples were prepared to supplement approach dissections. Results The far lateral approach provides a wide and versatile corridor for posterior fossa operation, with access spanning the entire cerebellopontine angle (CPA), foramen magnum, and upper cervical region. Key Steps Include The study includes the following steps: positioning and skin incision, myocutaneous flap, placement of burr holes and sigmoid trough, fashioning of the craniotomy bone flap, bilateral C1 laminectomy, occipital condyle/jugular tubercle drilling, and dural opening. Conclusion Although more cumbersome than the retrosigmoid approach, a far lateral craniotomy offers unparalleled access to lesions centered lower or more medially in the CPA, as well as those with significant extension into the clival or foramen magnum regions. Dissection-based neuroanatomic guides to operative approaches provide a unique and rich resource for trainees to comprehend, prepare for, practice, and perform complex cranial operations, such as the far lateral craniotomy.
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Affiliation(s)
- Christopher S Graffeo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona, United States.,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Lucas P Carlstrom
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Bachtri T Nguyen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
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Dao I, Sanou A, Alzouma H, Bako F, Hema Y, Zabsonré SD, Kabré A. Far Lateral Approach: "Trans-tumor Approach" on Huge Dumbbell-Shape Neurofibroma of Anterior Foramen Magnum Without Craniectomy-Anatomical Consideration and New Trend. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:125-130. [PMID: 38153460 DOI: 10.1007/978-3-031-36084-8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The foramen magnum approach is always challenging because of the relationships between vital neurovascular structures in this area. Several approaches have been described, among them, the far lateral approach remains a cornerstone for the resection of anterior or anterolateral processes of the foramen magnum. This approach displays two main steps: the first is cervical, whereas the second is cranial.We report the case of a 63 year-old woman admitted for a progressive quadriplegia with swallowing disorders revealing a process of the anterior and anterolateral part of the foramen magnum. A cervical step of a far lateral approach without opening the foramen magnum achieved a near total resection of the process via a trans-tumor corridor and confirmed a dumbbell shape neurofibroma. The postoperative period showed a resolution of swallowing disorders and a progressive improvement of muscular strength. At 8 months follow-up, she was asymptomatic and able to walk with a normal balance. The surgical technique and anatomical correlation of this trans-tumor approach are discussed.
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Affiliation(s)
- Ibrahim Dao
- Department of Neurosurgery, University Hospital Souro Sanou - Higher Institute of health sciences - Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Abdoulaye Sanou
- Department of Neurosurgery, University Hospital Souro Sanou - Higher Institute of health sciences - Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Haoua Alzouma
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo - Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Frédéric Bako
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo - Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Yves Hema
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo - Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Sylvain Delwendé Zabsonré
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo - Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Abel Kabré
- Department of Neurosurgery, University Hospital Yalgado Ouédraogo - Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
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Costello MC, Danish B, Patel NV, Kader M, Komotar RJ, Ivan ME. Commentary: Extended Transcondylar Approach With C1 Lateral Mass Resection for the Removal of a Calcified Ventral "Spinocranial" Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e193-e194. [PMID: 35972112 DOI: 10.1227/ons.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Meredith C Costello
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Medina EJ, Revuelta Barbero JM, Porto E, Garzon-Muvdi T, Henriquez O, Solares CA, Pradilla G. Exoscopic and Microscopic Combined Far Lateral Retrocondylar Approach for Resection of a Ventral Foramen Magnum Lesion: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e126. [PMID: 35838470 DOI: 10.1227/ons.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/24/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Eduardo J Medina
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Edoardo Porto
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Oswaldo Henriquez
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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7
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Exposing vertebral artery from lateral to medial under the guide of peri-vertebral artery fat pad in far lateral approach. Chin Med J (Engl) 2022; 135:468-470. [PMID: 35051976 PMCID: PMC8869517 DOI: 10.1097/cm9.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Di G, Zhou W, Fang X, Li Q, Sun L, Jiang X. Transmastoid Trautman's Triangle Combined Low Retrosigmoid Approach for Foramen Magnum Meningiomas: Surgical Anatomy and Technical Note. J Neurol Surg B Skull Base 2021; 82:659-667. [PMID: 34745834 DOI: 10.1055/s-0040-1713755] [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: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 10/22/2022] Open
Abstract
Objective This study was aimed to assess the potential of utilizing a transmastoid Trautman's triangle combined low retrosigmoid approach for ventral and ventrolateral foramen magnum meningiomas (FMMs) surgical treatment. Methods We simulated this transmastoid Trautman's triangle combined low retrosigmoid approach using five adult cadaveric heads to explore the associated anatomy in a step-by-step fashion, taking pictures of key positions as appropriate. We then employed this approach in a single overweight patient with a short neck who was suffering from large ventral FMMs and cerebellar tonsillar herniation. Results Through cadaver studies, we were able to confirm that this transmastoid Trautman's triangle combined with low retrosigmoid approach achieves satisfactory cranial nerve and vasculature visualization while also offering a wide view of the whole of the ventrolateral medulla oblongata. We, additionally, have successfully employed this approach to treat a single patient suffering from large ventral FMMs with cerebellar tonsillar herniation. Conclusion This transmastoid Trautman's triangle combined low retrosigmoid approach may represent a complement to treatment strategies for ventral and ventrolateral FMMs, particularly in patients with the potential for limited surgical positioning due to their being overweight, having a short neck and suffering from cerebellar tonsillar herniation.
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Affiliation(s)
- Guangfu Di
- Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China.,Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Xinyun Fang
- Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China.,Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
| | - Qiang Li
- Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
| | - Lean Sun
- Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China.,Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
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9
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Kina H, Erginoglu U, Hanalioglu S, Ozaydin B, Baskaya MK. Ovoid Foramen Magnum Shape is Associated with Increased Complications and Decreased Extent of Resection for Anterolateral Foramen Magnum Meningiomas. J Neurol Surg B Skull Base 2021; 82:682-688. [PMID: 34745837 DOI: 10.1055/s-0040-1715559] [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: 12/09/2019] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
Background Antero-laterally located meningiomas of the foramen magnum (FM) pose significant surgical resection challenges. The effect of FM shape on surgical resection of FM meningiomas has not been previously studied. The present study investigates how FM shape effects the extent of tumor resection and complication rates in antero-lateral FM meningiomas. Materials and Methods This retrospective study included 16 consecutive patients with antero-lateral FM meningiomas operated on by a single surgeon. FMs were classified as ovoid ( n = 8) and nonovoid ( n = 8) using radiographic evaluation. Results Sixteen patients were examined: seven males and nine females (mean age of 58.5, and range of 29 to 81 years). Gross total resection was achieved in 81% of patients, with tumor encased vertebral arteries in 44%. Patient characteristics were similar including age, sex, preoperative tumor volume, relationship of vertebral artery with tumor, preoperative Karnofsky performance score (KPS), symptom duration, and presence of lower cranial nerve symptoms. The ovoid FM group had lower volumetric extents of resection without statistical significance (93 ± 10 vs. 100 ± 0%, p = 0.069), more intraoperative blood loss (319 ± 75 vs. 219 ± 75 mL, p = 0.019), more complications per patient (1.9 ± 1.8 vs. 0.3 ± 0.4, p = 0.039), and poorer postoperative KPS (80 ± 21 vs. 96 ± 5, p = 0.007). Hypoglossal nerve palsy was more frequent in the ovoid FM group (38 vs. 13%). Conclusion This is the first study demonstrating that ovoid FMs may pose surgical challenges, poorer operative outcomes, and lower rates of extent of resection. Preoperative radiological investigation including morphometric FM measurement to determine if FMs are ovoid or nonovoid can improve surgical planning and complication avoidance.
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Affiliation(s)
- Hakan Kina
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Ufuk Erginoglu
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Sahin Hanalioglu
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Burak Ozaydin
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Mustafa K Baskaya
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
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10
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El Ahmadieh TY, Haider AS, Cohen-Gadol A. The Far-Lateral Suboccipital Approach to the Lesions of the Craniovertebral Junction. World Neurosurg 2021; 155:218-228. [PMID: 34724749 DOI: 10.1016/j.wneu.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
The far-lateral suboccipital approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are essential skull base techniques for the neurosurgeon to expose and treat pathologies located at the ventral and ventrolateral craniovertebral junction. An understanding of the surgical anatomy and technical nuances of these approaches is vital for preventing catastrophic brainstem or spinal cord injury, neurovascular injury, and/or cranial nerve injury. This is achieved by carefully studying the location, the rostral-caudal and lateral extents of the lesion itself, and the anatomy of the surrounding structures on preoperative imaging. The amount of bony exposure should be tailored to each specific lesion to avoid unnecessary bone drilling and therefore decrease the risk of potential craniocervical instability. Minimizing retraction of the cerebellum, brainstem, and spinal cord is important for preventing neurologic injury; therefore, appropriate intraoperative head positioning and adequate bony exposure should be ensured, especially for more ventrally located lesions. A thorough knowledge of the anatomy of the extradural and intradural segments of the vertebral artery, and the lower cranial nerves, in relation to the lesion is also critical. For almost all lesions, the far-lateral suboccipital route with no or minimal condylar drilling is more than adequate for removing the most ventral lesions. Herein, we discuss the indications, general and preoperative considerations, and surgical anatomy and technical nuances of this approach.
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Affiliation(s)
- Tarek Y El Ahmadieh
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, Texas, USA
| | - Aaron Cohen-Gadol
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA.
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11
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Fernandes MW, De Aguiar PHP, Galafassi GZ, De Aguiar PHSP, Raffa PEAZ, Maldaun MVC. Foramen magnum meningioma: Series of 20 cases. Complications, risk factors for relapse, and follow-up. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:406-411. [PMID: 35068824 PMCID: PMC8740810 DOI: 10.4103/jcvjs.jcvjs_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/06/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Meningiomas account for 2.2% to 2.5% of all cerebral tumors, of which only 2% are located in the foramen magnum. Foramen magnum meningiomas (FMMs) are commonly found in women, with a mean age at onset of 52 years old. They generally behave more aggressively than other meningiomas. Materials and Methods: We performed epidemiological, anatomical and surgical analyses of 20 patients diagnosed with FMMs who underwent surgical treatment from 1999 to 2019 at Santa Paula Hospital in Sao Paulo. This case series was compared with previously published ones to better understand this relatively rare disease. Results: Twenty patients were included, with a mean follow-up of 110 months. Their mean age was 37.8 years old. The mean preoperative Karnofsky performance status scale (KPS) was 84%. We found a female (65%) and left hemisphere predominance (50%). Involvement of both hemispheres was found in 25% of patients. FMM locations were anterior, anterolateral, lateral and posterior, in 45%, 35%, 10%, and 10%, respectively. Simpson resection grades I, II, and III were achieved in 25%, 60%, and 15% of cases, respectively. Mean postoperative KPS was 79%. Three patients with anterior and bilateral located meningiomas had a worse postoperative KPS in comparison to the preoperative one. Conclusion: Anterior and bilateral FMMs seem to be related to a worse prognosis. A gross total resection can reduce the recurrence rates. The KPS is worse in patients with recurrence.
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Affiliation(s)
- Maick Willen Fernandes
- Division of Neurosurgery, Santa Paula Hospital, Sao Paulo, Brazil.,Department of Post-graduation, State Serviant Public Hospital (IAMSPE), Sao Paulo, Brazil
| | - Paulo Henrique Pires De Aguiar
- Division of Neurosurgery, Santa Paula Hospital, Sao Paulo, Brazil.,Department of Post-graduation, State Serviant Public Hospital (IAMSPE), Sao Paulo, Brazil.,Department of Neurology, Pontifical Catholic University of Sao Paulo, Brazil.,Department of Neurosurgery, School of Medicine of ABC, Sao Paulo, Brazil
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12
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Visocchi M, Signorelli F, Parrilla C, Paludetti G, Rigante M. Multidisciplinary approach to the craniovertebral junction. Historical insights, current and future perspectives in the neurosurgical and otorhinolaryngological alliance. ACTA ACUST UNITED AC 2021; 41:S51-S58. [PMID: 34060520 PMCID: PMC8172108 DOI: 10.14639/0392-100x-suppl.1-41-2021-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
Historically considered as a nobody’s land, craniovertebral junction (CVJ) surgery or specialty recently gained high consideration as symbol of challenging surgery as well as selective top level qualifying surgery. The alliance between Neurosurgeons and Otorhinolaringologists has become stronger in the time. CVJ has unique anatomical bone and neurovascular structures architecture. It not only separates from the subaxial cervical spine but it also provides a special cranial flexion, extension, and axial rotation pattern. Stability is provided by a complex combination of osseous and ligamentous supports which allows a large degree of motion. The perfect knowledge of CVJ anatomy and physiology allows to better understand surgical procedures of the occiput, atlas and axis and the specific diseases that affect the region. Although many years passed since the beginning of this pioneering surgery, managing lesions situated in the anterior aspect of the CVJ still remains a challenging neurosurgical problem. Many studies are available in the literature so far aiming to examine the microsurgical anatomy of both the anterior and posterior extradural and intradural aspects of the CVJ as well as the differences in all the possible surgical exposures obtained by 360° approach philosophy. Herein we provide a short but quite complete at glance tour across the personal experience and publications and the more recent literature available in order to highlight where this alliance between Neurosurgeon and Otorhinolaringologist is mandatory, strongly advisable or unnecessary.
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Affiliation(s)
- Massimiliano Visocchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.,Craniovertebral Junction Operative Unit, Master II Degree, Cadaver Lab and Research Center on Craniocervical Junction Surgery, Catholic University School of Medicine, Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Parrilla
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy.,Craniovertebral Junction Operative Unit, Master II Degree, Cadaver Lab and Research Center on Craniocervical Junction Surgery, Catholic University School of Medicine, Rome, Italy
| | - Mario Rigante
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy.,Craniovertebral Junction Operative Unit, Master II Degree, Cadaver Lab and Research Center on Craniocervical Junction Surgery, Catholic University School of Medicine, Rome, Italy
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Hammed A, Mahfoud M, Sulaiman A, Najm A, Hammed S. Complete resection of pure anterior foramen magnum meningioma without neurovascular injuries poses a big challenge: Case report. Ann Med Surg (Lond) 2021; 64:102265. [PMID: 33868685 PMCID: PMC8040125 DOI: 10.1016/j.amsu.2021.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction and importance Meningiomas are common neoplasms representing 14.3–19% of all intracranial tumors. Among all the meningiomas, only 1.8–3.2% arises at the foramen magnum (FM) level. Most of the lesions (68%–98%) arising anterolaterally, followed by postolateral, purely posterior and, more rarely, purely anterior. Case presentation We report a case of A 42-year-old female presented with a history of neck pain with progressive spastic hemiparesis. Clinical Discussion MRI revealed well-defied pure anterior and on both sides of vertebral artery, foramen magnum lesion. Through conservative transcondylar approach, Lesion was removed totally in a piecemeal fashion. Histopathology revealed meningothelial meningioma. The patient had a dramatic recovery. Conclusion The exposure allowed by the far-lateral retrocondylar or partial transcondylar approach is adequate for resecting even anterior intradural FMMs. Reports about Foramen magnum meningioma aren't common, but reports on pure anterior foramen magnum meningioma are very rare. The prerequisite for treating FM meningiomas (FMMs) is the perfect knowledge of the surgical anatomy. The opportunity to give the patient a symptom-free and normal life should not be missed in such cases. Only 1.8–3.2% of all meningiomas are located at foramen magnum (FM). Foramen magnum meningiomas (FMMs) represent a common histological tumor in a rare and eloquent location. FMMs are one of the most surgically complex conditions in neuro-oncologic surgery. The transcondylar approach is a more advanced technique and the total removal of ventral lesion could be achieved.
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Affiliation(s)
- Ali Hammed
- Tishreen University Hospital, Department of Neurosurgery. Lattakia, Syria
| | - Moufid Mahfoud
- Tishreen University Hospital, Department of Neurosurgery. Lattakia, Syria
| | - Alaa Sulaiman
- Tishreen University Hospital, Department of Neurosurgery. Lattakia, Syria
| | - Adnan Najm
- Tishreen University Hospital, Department of Neurosurgery. Lattakia, Syria
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Li L, Lan Z, Richard SA, Zhang Y. Foramen magnum meningioma with excessive calcification and no dura tail sign: A case report. Medicine (Baltimore) 2021; 100:e24704. [PMID: 33578608 PMCID: PMC10545170 DOI: 10.1097/md.0000000000024704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Foramen magnum meningiomas are very rare lesions. They frequently originate from the arachnoid cells at the dura matter of the craniocervical junction. Foramen magnum meningiomas are challenging for neurosurgeons because of the complex anatomy of foramen magnum. We present a rare case of FMM with excessive calcification and without the dura tail sign which made the lesion mimic a teratoma. PATIENTS CONCERNS A 63 years old woman presented with progressive numbness and hyperesthesia of the shoulders and upper limbs for 2 and half years. She also experienced occasional headaches and dizziness with no nausea, vomiting or fever. DIAGNOSES Computed tomography scan, and magnetic resonance imaging revealed a calcified mass at occipital cistern. The lesion did not show the usual "dura tail sign" which made it mimic a teratoma on magnetic resonance imaging. Histopathology established meningioma. INTERVENTION The tumor was completely resected via suboccipital approach. OUTCOMES Two years follow-up revealed no recurrence of the lesion and no neurological deficits. LESSONS We advocate the use of electromyographic and auditory brainstem responses to monitor the inferior cranial nerves because the tumor often adheres to these nerves.
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Affiliation(s)
- Li Li
- Department of Neurosurgery, West China Hospital, Sichuan University; 37 Guo Xue Xiang Road, Chengdu, Sichuan
| | - Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University; 37 Guo Xue Xiang Road, Chengdu, Sichuan
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University; 37 Guo Xue Xiang Road, Chengdu, Sichuan
- Department of Medicine, Princefield University, P. O. Box MA 128, Ho-Volta Region, Ghana, West Africa
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University; 37 Guo Xue Xiang Road, Chengdu, Sichuan
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Foramen magnum meningiomas: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:2583-2596. [PMID: 33507444 PMCID: PMC8490226 DOI: 10.1007/s10143-021-01478-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
Foramen magnum meningiomas (FMMs) account for 1.8–3.2% of all meningiomas. With this systematic review and meta-analysis, our goal is to detail epidemiology, clinical features, surgical aspects, and outcomes of this rare pathology. Using PRISMA 2015 guidelines, we reviewed case series, mixed series, or retrospective observational cohorts with description of surgical technique, patient and lesion characteristics, and pre- and postoperative clinical status. A meta-analysis was performed to search for correlations between meningioma characteristics and rate of gross total resection (GTR). We considered 33 retrospective studies or case series, including 1053 patients, mostly females (53.8%), with a mean age of 52 years. The mean follow-up was of 51 months (range 0–258 months). 65.6% of meningiomas were anterior, and the mean diameter was of 29 mm, treated with different surgical approaches. Postoperatively, 17.2% suffered complications (both surgery- and non-surgery-related) and 2.5% had a recurrence. The Karnofsky performance score improved in average after surgical treatment (75 vs. 81, p < 0.001). Our meta-analysis shows significant rates of GTR in cohorts with a majority of posterior and laterally located FMM (p = 0.025) and with a mean tumor less than 25 mm (p < 0.05). FMM is a rare and challenging pathology whose treatment should be multidisciplinary, focusing on quality of life. Surgery still remains the gold standard and aim at maximal resection with neurological function preservation. Adjuvant therapies are needed in case of subtotal removal, non-grade I lesions, or recurrence. Specific risk factors for recurrence, other than Simpson grading, need further research.
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16
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Signorelli F, Olivi A, De Giorgio F, Pascali VL, Visocchi M. A 360° Approach to the Craniovertebral Junction in a Cadaveric Laboratory Setting: Historical Insights, Current, and Future Perspectives in a Comparative Study. World Neurosurg 2020; 140:564-573. [PMID: 32797988 DOI: 10.1016/j.wneu.2020.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We herein outline the experience matured in our equipped Cranio-Vertebral Junction Laboratory for anatomic dissection. METHODS An extreme lateral approach (ELA) was performed on 4 fresh cadavers and submandibular approach was performed on 5. An endoscope and navigation-assisted far lateral approach (FLA) was performed in 5 injected specimens. In these specimens, a transoral approach was also performed, as well as a neuronavigation-assisted comparison between transoral and transnasal explorable distances. RESULTS As calculated with neuronavigation, statistically significant differences both in the explored craniocaudal (P = 0.003) and lateral (P = 0.008) distances were observed between the transoral approach and endoscopic endonasal approach. In FLA, neuronavigation facilitated identification and partial removal of the occipital condyle; in one case, during endoscopic intradural exploration, tearing of the emerging roots of the 11th cranial nerve occurred. In ELA, the site where the accessory nerve pierces into the sternocleidomastoid muscle was found at a distance from the tip of the mastoid between 3 and 4 cm. CONCLUSIONS During dissections, as in the clinical setting, endoscope and image guidance give the surgeon a constant orientation, increasing the accuracy and the safety of the approach. Nonetheless, the encumbrance of the endoscope could represent a limit in deep and narrow corridors as those running across the craniovertebral junction, especially in "oblique" FLA and ELA, in which the surgical target is often hidden by a delicate tangle of nerves and vessels. Its use appears more suitable and safer in "straight" approaches as transoral and transnasal in which there are no neurovascular structures interposed.
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Affiliation(s)
- Francesco Signorelli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Fabio De Giorgio
- Institute of Public Health, Section of Legal Medicine, Catholic University School of Medicine, Rome, Italy
| | - Vincenzo Lorenzo Pascali
- Institute of Public Health, Section of Legal Medicine, Catholic University School of Medicine, Rome, Italy
| | - Massimiliano Visocchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Craniovertebral Junction Operative Unit, Master II Degree and Research Center Craniocervical Junction Surgery, Catholic University School of Medicine, Rome, Italy
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17
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Song G, Cheng Y, Bai X, Ren J, Li M, Meng G, Tang J, Liang J, Guo H, Chen G, Bao Y, Xiao X. Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach. World Neurosurg 2020; 146:e1242-e1254. [PMID: 33276173 DOI: 10.1016/j.wneu.2020.11.140] [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: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach. METHODS From July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves. RESULTS Thirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period. CONCLUSIONS We established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.
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Affiliation(s)
- Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guolu Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Abou-Madawi AM, ElKazaz MK, Alshatoury HA, Ali SH. Far-Lateral Approach for Ventral and Ventrolateral Upper Cervical Meningiomas: A Case Series and Literature Review. Asian Spine J 2020; 15:584-595. [PMID: 33160298 PMCID: PMC8561145 DOI: 10.31616/asj.2020.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To evaluate the safety and efficacy of the far-lateral approach in the resection of ventral and ventrolateral upper cervical meningiomas. OVERVIEW OF LITERATURE Upper cervical meningiomas are a common disease entity. These lesions can be surgically treated via many accesses. The far-lateral approach is a very appealing technique for these lesions. METHODS We assessed 23 patients with a mean age of 57.3±15 years. According to the Japanese Orthopedic Association (JOA) scale; eight patients had grade 0, nine had grade I, and six had grade II. All patients underwent plain radiography and magnetic resonance imaging of the cervical spine. The foramen magnum was involved in 10 patients, C1-2 in seven, C2-3 in four, and C3-4 in two. All patients were operated via the far-lateral approach. RESULTS Gross total resection was achieved in 21 patients. Sixteen lesions were psammomatous, five were fibroblastic, and two were meningothelial meningiomas. The mean operative duration was 135±40 minutes, while the mean operative blood loss was 450±210 mL, and the mean hospital stay was 4.3±2.2 days. At the final follow-up that was conducted at 27.6±21 months and as per the JOA score; 16 patients were classified into grade 0 and 7 into grade II. The condition of none of our patients deteriorated postoperatively. There was no significant correlation of the clinical outcome with tumor level, pathological subtype of the tumor, symptom duration, age, and sex. There was no significant correlation of tumor resection completeness with tumor level, tumor pathological subtype, or tumor topography (ventral or ventrolateral). CONCLUSIONS The far-lateral approach is a safe and effective access for ventral and ventrolateral cervical meningiomas. It allows direct access to tumor with no spinal cord or nerve roots traction, and thus may yield a fairly better outcome than the standard posterior approach.
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Affiliation(s)
- Ali M Abou-Madawi
- Department of Neurosurgery, Suez Canal University Hospital, Ismailia, Egypt
| | - Mohamed K ElKazaz
- Department of Neurosurgery, Suez Canal University Hospital, Ismailia, Egypt
| | | | - Sherif H Ali
- Department of Neurosurgery, Suez Canal University Hospital, Ismailia, Egypt
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19
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Sai Kiran NA, Sivaraju L, Furtado SV, Vidyasagar K, Raj V, Aryan S, Thakar S, Mohan D, Hegde AS. Far lateral approach without occipital condylar resection for intradural ventral/ventrolateral foramen magnum tumors and aneurysms of V4 segment of vertebral artery: Review of surgical results. Clin Neurol Neurosurg 2020; 197:106163. [PMID: 32916393 DOI: 10.1016/j.clineuro.2020.106163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Controversies exist regarding the need and extent of condylar resection for safe surgical management of intradural ventral/ventrolateral foramen magnum (VFM) tumors and aneurysms of V4 segment of vertebral artery (VA) by far lateral approach. This retrospective study was conducted to evaluate the results of basic far lateral approach(retrocondylar approach) without upfront occipital condylar resection. METHODS AND RESULTS Twenty one patients underwent surgery via far lateral approach for intradural VFM tumors and aneurysms of V4 segment of VA at Sri Sathya Sai Institute of Higher Medical Sciences during 9 years(2008-2016) study period. Eight patients had VA aneurysms and 13 patients had intradural VFM tumors. After basic far lateral approach(retrocondylar approach), dura was opened and checked if the exposure was adequate for safe surgery. Retrocondylar approach provided adequate exposure for all these lesions and resection of occipital condyle/jugular tubercle was not required in any of these cases. Skeletonization or transposition of VA was not done in any of these cases. Gross total resection of the tumor could be done in 9 patients(9/13-69.2 %) and near total excision (>95 %) in 4 patients (4/13-30.8 %). Seven of the 8 VA aneurysms were successfully clipped. Outcome at a final follow up of 3 months or more was good(mRS<2) in 19 patients(19/21-90.5 %) and poor in 2 patients. Complications included lower cranial nerve deficits [transient-2/21(9.5 %), persisting-2/21(9.5 %)], motor deficits(2/21-9.5%), seventh nerve paresis(1/21-4.8%), sixth nerve paresis(2/21-9.5%) and pseudomeningocele(1/21-4.8%). CONCLUSION Basic far lateral (retrocondylar) approach provides excellent exposure for majority of VFM tumors and aneurysms of V4 segment of VA. Condylar resection(transcondylar approach), drilling of jugular tubercle (transtubercular approach), skeletonization/transposition of VA might not be required for safe surgical management of majority of these lesions.
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Affiliation(s)
- Narayanam Anantha Sai Kiran
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Laxminadh Sivaraju
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.
| | - Sunil Valentine Furtado
- Department and Institution, Department of Neurosurgery, MS Ramaiah Medical College and Hospital, M S Ramaiah Nagar, Mathikere, Bangalore, 560054, India
| | - Kanneganti Vidyasagar
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Vivek Raj
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Saritha Aryan
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Sumit Thakar
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Dilip Mohan
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Alangar S Hegde
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
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20
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Goel A, Darji H, Shah A, Rai S, Biswas C, Lunawat A. Ossified Anterior Foramen Magnum Meningioma: Report of Long-Term Surgical Outcome. World Neurosurg 2020; 141:59-63. [PMID: 32526364 DOI: 10.1016/j.wneu.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Technical surgery-related issues for large ossified/calcified meningioma that encased one or both vertebral arteries located anterior to brainstem in the region of foramen magnum are discussed. Relatively long-term outcome of successful surgery is reported. CASE DESCRIPTION Three women were operated on for symptoms of progressive quadriparesis. Investigations revealed ossified meningioma located anterior to the brainstem. One or both vertebral arteries were encased within the confines of the tumor. Large size, bone-hard consistency, location anterior to the brainstem, and intimate vascular relationship made the surgery a formidable surgical problem. A midline posterior suboccipital approach was used to resect these tumors. Radical tumor resection was achieved in all cases successfully. Tumor drilling or heavy tumor breaking instruments were not necessary to debulk the tumor. Histologic examination in all 3 cases revealed psammomatous meningioma. During the follow-up period that ranged from 2 to 12 years, all 3 patients were leading a normal life, and there has been no documented recurrence in any case. CONCLUSIONS Successful resection of "ossified" meningioma is associated with satisfactory long-term clinical outcome.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India.
| | - Hardik Darji
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Survendra Rai
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Chandrima Biswas
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Aditya Lunawat
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
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Scoville JP, Mazur MD, Couldwell WT. Unique Far-Lateral Closure Technique: Technical Note. Oper Neurosurg (Hagerstown) 2020; 18:384-390. [PMID: 31236599 DOI: 10.1093/ons/opz168] [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: 08/27/2018] [Accepted: 03/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The far-lateral approach is a mainstay in gaining access to the ventrolateral craniocervical junction for tumor removal and the treatment of vascular lesions. It has a reportedly high rate of cerebrospinal fluid leak (up to 20%), which can bring devastating consequences, including meningitis, and may require wound revision associated with a longer hospital stay. OBJECTIVE To describe a closure technique employed to close the access corridor provided by the far-lateral approach and present an illustrative case. METHODS The far-lateral closure technique employs dural closure, followed by fat buttress, to alleviate dead space and reduce the likelihood of fluid collection and leakage. RESULTS This technique has been successfully used by the senior author for more than 14 yr, with a rate of cerebrospinal fluid leak of 2.9%. CONCLUSION This unique approach and closure of the far-lateral craniotomy is a reasonable option for the approach to the ventrolateral craniocervical junction. Skull base surgeons can consider the use of this closure technique to ensure watertight closure.
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Affiliation(s)
- Jonathan Perry Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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22
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Open and Endoscopic Skull Base Approaches. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Platt A, Stamates MM, Wong RH. Minimally Invasive Tubular Approach for Occipital Condylar Biopsy and Resection: Case Report and Review of Literature. World Neurosurg 2020; 137:276-280. [PMID: 32084613 DOI: 10.1016/j.wneu.2020.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with isolated occipital condyle lesions concerning for metastases rarely undergo surgical biopsies and are more commonly treated with empirical radiation with or without chemotherapy. This is likely related to the morbidity associated with open condylar approaches and the importance of surrounding structures. We present a minimally invasive technique to approach the occipital condyle using a tubular dilating retractor system. CASE DESCRIPTION A 38-year-old woman with medical history of breast cancer presented with a 2-month history of headache localizing to the right occipital area and right tongue deviation. Magnetic resonance imaging revealed a heterogeneously enhancing mass within the right occipital condyle. The patient was brought into the operating room and placed in prone position. A 2-cm paramedian incision was made on the right approximately 2.5 cm off midline at the level of C1. Sequential dilation using a tubular retractor system was performed under fluoroscopic guidance. Once the condylar cortex was identified and entered, the tumor was immediately visualized and resected. Operative time was 65 minutes and estimated blood loss was 5 mL. The patient was discharged to home on postoperative day 1. CONCLUSIONS This report, to our knowledge, presents the first case of a minimally invasive tubular retractor system-based approach for biopsy and resection of an occipital condylar metastasis causing occipital condyle syndrome. This approach allows for tissue diagnosis to precisely dictate medical management and minimizes the morbidity associated with traditional open surgical approaches.
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Affiliation(s)
- Andrew Platt
- Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA
| | - Melissa M Stamates
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Ricky H Wong
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
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The Benefits of Progressive Occipital Condylectomy in Enhancing the Far Lateral Approach to the Foramen Magnum. World Neurosurg 2020; 134:e144-e152. [DOI: 10.1016/j.wneu.2019.09.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
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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: 0.3] [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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Abstract
The foramen magnum meningioma (FMM) is one of most challenging tumors among all the meningiomas because of its distinctive location, clinical course, insidious onset, and the relative large size of the tumor during presentation. These tumors are slow-growing and clinical symptoms vary according to involvement of different structures including the spinal cord, vertebral artery, lower cranial nerves, and medulla oblongata. Controversies regarding appropriate surgical approach for resection of tumor in this unique location continue. Tumors in the posterior or posterolateral region of the foramen magnum is accessible by midline suboccipital approach. The anterior and anterolateral tumors are encountered by various modifications of the far lateral approach. Drilling of condylar fossa is adequate in most of the cases as tumors often create a surgical corridor. However, an anterior tumor with significant extension on both sides of midline may require variable amounts of condyle resection. Here we review the FMMs with an emphasis on surgical approaches.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Tanmoy K Maiti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Anil Nanda
- Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, NJ, United States.
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Kumar A, Konar S, Hussain N, Chaturvedi J. Mirror meningioma at foramen magnum: Enigma in management of a very rare case. Surg Neurol Int 2019; 10:230. [PMID: 31893131 PMCID: PMC6911672 DOI: 10.25259/sni_437_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background: We report a very rare case of bilateral foramen magnum mirror meningioma and discuss difficulties in managing the surgical challenge. To the best of our knowledge, mirror foramen magnum meningioma (FMM) has been reported only once in literature. FMMs are rare and also a great challenge for neurosurgeons due to the complex anatomy of this area. The purpose of this article is to illustrate the rare occurrence of bilateral meningioma in the foramen magnum and the difficulties in managing the surgical challenge. Case Description: A case of a 45-year-old female presented with neck pain, paresthesia in all four limbs, and difficulty in walking for 1 year duration. Magnetic resonance imaging revealed well-defined lobulated dural based mass lesion at foramen magnum on both sides. The left vertebral artery (VA) was encased within the lesion while the right VA was seen abutting it. Tumor was resected gross totally on the right side. However, during the resection of the medial part of the left side tumor, it was found to be adhered to the VA. Since the mass was adherent to the left VA, subtotal resection was done. Conclusion: There is no single best surgical approach for FMMs and the optimal approach should be defined according to the localization and the extent of the tumor to minimize the extent of resultant morbidity. Although complete excision of the tumor is the aim of surgery, it is safer to leave portions of tumor that is adherent to critical structures which can be managed by Gamma Knife radiosurgery.
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Affiliation(s)
- Anil Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Nighat Hussain
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Jitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
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Bilgin E, Çavus G, Açik V, Arslan A, Olguner SK, Istemen I, Gezercan Y, Ökten AI. Our surgical experience in foramen magnum meningiomas: clinical series of 11 cases. Pan Afr Med J 2019; 34:5. [PMID: 31762874 PMCID: PMC6850739 DOI: 10.11604/pamj.2019.34.5.17536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 08/23/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction We aimed to discuss surgical approaches and results that we applied foramen magnum meningiomas. Methods We retrospectively investigated 11 foramen magnum meningioma cases, who had been operated between the dates of February 2012 and March 2017. Results Eight of the patients were females and 3 of the patients were males, the age range was 32-75 and the age average was 60.8. 5 of the tumors were anatomically localized as posterolateral, 2 of them were localized as anterolateral, 2 of them were localized as lateral and 2 of them were localized as anterior according to the brain stem or spinal cord. Posterior far lateral (4 patients) approach including C1 laminoplasty (7 patients) and 1/3 condyle resection was surgically applied to the patients with median suboccipital craniotomy. Gross total excision was applied to 82% of the patients (9 patients) and subtotal mass excision was applied to 18% (2 patients) of the patients. The most frequent post-operative complications were temporary lower cranial nerve (CN IX and X ) palsy in our 2 anterior localized cases (18%) and also cerebrospinal fluid (CSF) fistula in our 1 anterior localized case with difficulty in swallowing (dysphagia). Karnofsky scores of the patients, who were followed for 18 months in post-operative 12 and 48 months of average, in the last follow-up were 80 and no post-operative mortality occurred. Conclusion Posterior midline suboccipital and far lateral approaches that we apply in our own series were appropriate approaches for foramen magnum meningiomas.
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Affiliation(s)
- Emre Bilgin
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | - Gökhan Çavus
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | - Vedat Açik
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | - Ali Arslan
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | | | - Ismail Istemen
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | - Yurdal Gezercan
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
| | - Ali Ihsan Ökten
- Adana City Training and Research Hospital, Neurosurgery Clinic, Adana, Turkey
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Adada B, Vera Silva MA, Darwish H, Dakwar E. Far-lateral trans-atlas extradural resection of retro-odontoid synovial cyst: Surgical technique and review of literature. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Alshafai NS, Klepinowski T. The Far Lateral Approach to the Craniovertebral Junction: An Update. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:159-164. [PMID: 30610317 DOI: 10.1007/978-3-319-62515-7_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially. OBJECTIVE In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others. METHODS We reviewed all articles touching upon the FLA in the modern era (from the year 2000 onward) and selected those that presented a significant contribution to the development of the relevant approach. The database used was PubMed. RESULTS AND CONCLUSION We found several new caveats not mentioned in other reviews or book chapters. The FLA is an ever-changing field of battle where the common and ultimate goals are to minimize the risk of injuring the major vessel in the region-the vertebral artery-and to provide such an angle of attack upon the tumours in the anterior and anterolateral foramen magnum that it is feasible to ensure gross total resection. This paper is an update on the knowledge about this approach, which we feel is necessary.
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Affiliation(s)
| | - Tomasz Klepinowski
- Department of Neurosurgery, Collegium Medicum Jagiellonian University, Alshafai Neurosurgical Academy (ANA), Kraków, Poland
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Tayebi Meybodi A, Borba Moreira L, Zhao X, Preul MC, Lawton MT. Anatomical Analysis of the Vagoaccessory Triangle and the Triangles Within: The Suprahypoglossal, Infrahypoglossal, and Hypoglossal–Hypoglossal Triangles. World Neurosurg 2019; 126:e463-e472. [DOI: 10.1016/j.wneu.2019.02.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
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Magill ST, Shahin MN, Lucas CHG, Yen AJ, Lee DS, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical Outcomes, Complications, and Management Strategies for Foramen Magnum Meningiomas. J Neurol Surg B Skull Base 2019; 80:1-9. [PMID: 30733894 PMCID: PMC6365236 DOI: 10.1055/s-0038-1654702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/15/2018] [Indexed: 10/14/2022] Open
Abstract
Objectives Foramen magnum meningiomas (FMM) are complex lesions because of their proximity to the brain stem and posterior cerebrovasculature. The objective of this study is to report surgical outcomes and complications after resection of FMM. Methods A retrospective chart review was conducted on patients with FMM from 1998 to 2015. Univariate logistic regression and recursive partitioning analysis were used to identify risk factors associated with complications and extent of resection (EOR). Results We identified 28 patients with FMM. Median follow-up was 5.9 years. Tumors were World Health Organization grade I (92.9%) or grade II (7.1%). The vertebral artery was completely encased (25%), partially encased (11%), or not encased (64%). Median size was 11.9 cm 3 . EOR was gross total (39%) and subtotal (61%). The observed recurrence rate was 4% ( n = 1). There were 38 complications in 12 patients (43%), and 6 patients (21%) had complications requiring additional surgery. Complications included cerebrospinal fluid leak/hydrocephalus ( n = 7, 25%), weakness ( n = 4, 14%), numbness ( n = 4, 14%), and cranial nerve deficits: IX, X ( n = 4, 14%), XI ( n = 2, 7%), XII ( n = 5, 18%). Medical complications included pneumonia ( n = 1, 4%) and meningitis ( n = 1, 4%). Tumor volume greater than 14 cm 3 (odds ratio [OR] = 21.7, p = 0.0010), any vertebral artery encasement (OR 6.1, p = 0.0386), and subtotal resection (OR 6.4, p = 0.0398) were significantly associated with complications. Tumor volume greater than 14 cm 3 was also significantly associated with subtotal resection (OR 8.3, p = 0.0201). Conclusions Resection of FMM carries perioperative morbidity that increases with larger tumor size. Despite the morbidity, long-term recurrence-free survival is achievable with maximal safe resection and adjuvant radiation.
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Affiliation(s)
- Stephen T. Magill
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Maryam N. Shahin
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Calixto-Hope G. Lucas
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Adam J. Yen
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - David S. Lee
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - David R. Raleigh
- Department of Neurological Surgery, University of California, San Francisco, California, United States
- Department of Radiation Oncology, University of California, San Francisco, California, United States
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Philip V. Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California, San Francisco, California, United States
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Raco A, Pesce A, Toccaceli G, Frati A, Dugoni DE, Delfini R. Quality of Life After Craniovertebral Junction Meningioma Resection: Shaping the Real Neurologic and Functional Expectancies About These Surgeries in a Contemporary Large Multicenter Experience. World Neurosurg 2018; 110:583-591. [PMID: 29433183 DOI: 10.1016/j.wneu.2017.05.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/27/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Craniovertebral junction (CVJ) meningiomas are one of the most surgically complex conditions in neuro-oncologic surgery. The aim of this work is to correlate our data with clinical outcome to outline factors leading to a worse functional prognosis. METHODS We analyzed sex, age, clinical presentation, topography, surgical approach, Simpson grade resection, postoperative lower cranial nerve deficits, consistency, histology, site of origin, presence of a capsule, and radiologic and clinical follow-up at 1, 6, and 12 months of 61 patients affected by CVJ meningiomas, operated on in our institution from 1992 to 2014. RESULTS 78.7% of patients were women (mean age, 52.85 years); the onset symptom was pain in 65.5% of cases. The mean preoperative Nurick grade of the sample was 3.78; the most frequent histologic type was endotheliomatous (42.8%). We treated 22 patients with a posterior median approach (5 with lateral and 17 with posterolateral axial topography); in 39 cases (30 anterolateral and 9 anterior) we performed a posterolateral approach. Gross total removal was achieved in 85.2% of cases. We recorded a final follow-up step overall neurologic improvement in the cohort (average preoperative Nurick grade, 3.81, and at 12 months, 2.13). Twenty-nine patients presented with lower cranial nerve deficit (permanent or transient) and no statistically significant association was found between surgical approach and temporary or permanent postoperative complications. CONCLUSIONS We selected, in our experience, some predictors of worse outcome: preoperative sphincter impairment, absence of a capsule, cranial site of origin, a poor preoperative functional status, and firm consistency of the tumor.
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Affiliation(s)
- Antonino Raco
- Division of Neurosurgery, NESMOS Department, Sapienza University, Rome, Italy; Azienda Ospedaliera Sant'Andrea, Division of Neurosurgery, Rome, Italy.
| | - Alessandro Pesce
- Division of Neurosurgery, NESMOS Department, Sapienza University, Rome, Italy; Azienda Ospedaliera Sant'Andrea, Division of Neurosurgery, Rome, Italy
| | - Giada Toccaceli
- Division of Neurosurgery, NESMOS Department, Sapienza University, Rome, Italy; Azienda Ospedaliera Sant'Andrea, Division of Neurosurgery, Rome, Italy
| | - Alessandro Frati
- IRCCS "Neuromed" - Neurosurgery Division, "Sapienza University", Pozzilli (IS), Italy
| | | | - Roberto Delfini
- Policlinico Umberto I, Division of Neurosurgery, Rome, Italy
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Madhavan K, Chieng LO, Gaynor BG, Levi AD. Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases. J Neurosurg Spine 2018; 28:236-243. [DOI: 10.3171/2017.6.spine17429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Retro-odontoid cysts that arise from the tectorial membrane are uncommon lesions that can occur in elderly patients. They arise secondary to degenerative changes, including calcium pyrophosphate deposition within the ligaments. Surgical treatment is indicated when these lesions result in intractable pain, instability, and/or myelopathy. Several surgical techniques to treat this condition exist, but the optimal approach in elderly patients with comorbidities remains controversial. Here, the authors present a case series of 3 patients who underwent successful resection of a retro-odontoid lesion performed through a transdural approach.The patients were 70, 81, and 74 years old and presented with symptoms of cervical myelopathy. In consideration of their advanced age and the location of their lesion, resection via a posterior approach was considered. A 1- to 2-cm suboccipital craniectomy and C-1 and partial C-2 laminectomy were performed. These lesions could not be accessed via an extradural posterolateral approach, and so a transdural approach was performed. In the first 2 patients, a preexisting deformity prompted an instrumented fusion. In the third patient, only a lesion resection was performed. In each case, the dural opening was made using a paramedian ipsilateral-sided incision, and the lesion was resected through an incision in the anterior dura mater. Only the posterior dura was closed primarily. MR imaging evidence of excellent spinal cord decompression was evident in follow-up examinations.Transdural resection of retro-odontoid cysts is a viable option for treating asymmetrical ventral extradural cysts. Results from this case series suggest that such an approach is safe and feasible and can provide an alternative to open or endoscopic anterior transpharyngeal approaches.
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Mehta GU, Zenonos G, Patibandla MR, Lin CJ, Wolf A, Grills I, Mathieu D, McShane B, Lee JY, Blas K, Kondziolka D, Lee CC, Lunsford LD, Sheehan JP. Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. J Neurosurg 2017; 129:383-389. [PMID: 28862549 DOI: 10.3171/2017.3.jns163008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas are the most common benign extramedullary lesions of the foramen magnum; however, their optimal management remains undefined. Given their location, foramen magnum meningiomas (FMMs) can cause significant morbidity, and complete microsurgical removal can be challenging. Anterior and anterolateral FMMs carry greater risks with surgery, but they comprise the majority of these lesions. As an alternative to resection, stereotactic radiosurgery (SRS) has been used to treat FMMs in small case series. To more clearly define the outcomes of SRS and to delineate a rational management paradigm for these lesions, the authors analyzed the safety and efficacy of SRS for FMM in an international multicenter trial. METHODS Seven medical centers participating in the International Gamma Knife Research Foundation (IGKRF) provided data for this retrospective cohort study. Patients who were treated with Gamma Knife radiosurgery and whose clinical and radiological follow-up was longer than 6 months were eligible for study inclusion. Data from pre- and post-SRS radiological and clinical evaluations were analyzed. Stereotactic radiosurgery treatment variables were recorded. RESULTS Fifty-seven patients (39 females and 18 males, with a median age of 64 years) met the study inclusion criteria. Thirty-two percent had undergone prior microsurgical resection. Patients most frequently presented with cranial neuropathy (39%), headache (35%), numbness (32%), and ataxia (30%). Median pre-SRS tumor volume was 2.9 cm3. Median SRS margin dose was 12.5 Gy (range 10-16 Gy). At the last follow-up after SRS, 49% of tumors were stable, 44% had regressed, and 7% had progressed. Progression-free survival rates at 5 and 10 years were each 92%. A greater margin dose was associated with a significantly increased likelihood of tumor regression, with 53% of tumors treated with > 12 Gy regressing. Fifty-two percent of symptomatic patients noted some clinical improvement. Adverse radiation effects were limited to hearing loss and numbness in 1 patient (2%). CONCLUSIONS Stereotactic radiosurgery for FMM frequently results in tumor control or tumor regression, as well as symptom improvement. Margin doses > 12 Gy were associated with increased rates of tumor regression. Stereotactic radiosurgery was generally safe and well tolerated. Given its risk-benefit profile, SRS may be particularly useful in the management of small- to moderate-volume anterior and anterolateral FMMs.
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Affiliation(s)
- Gautam U Mehta
- 1Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Georgios Zenonos
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Mohana Rao Patibandla
- 1Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | | | - Amparo Wolf
- 4Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Inga Grills
- 5Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - David Mathieu
- 6Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Brendan McShane
- 7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Y Lee
- 7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Blas
- 5Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Douglas Kondziolka
- 4Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Cheng-Chia Lee
- 8Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia
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Kondrakhov SV, Zakharova NE, Fadeeva LM, Tanyashin SV. [Phase contrast MRI-based evaluation of cerebrospinal fluid circulation parameters in patients with foramen magnum meningiomas]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 80:42-54. [PMID: 28139572 DOI: 10.17116/neiro201680642-54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Meningiomas of the foramen magnum (FMR) region account for 1.8 to 3.2% of all meningiomas. The international literature has insufficient data describing the state of cerebrospinal fluid (CSF) circulation in these patients. MATERIAL AND METHODS We studied 38 patients with FM meningiomas, aged from 35 to 79 years (mean age, 56.7 years). The mean meningioma size was 30 mm (10-60 mm). Meningiomas had the anterolateral localization in 29 patients, ventral localization in 5 patients, and dorsal localization in 4 patients. Twenty nine patients underwent surgery. All operated patients were examined before and after surgery. The CSF circulation was studied using phase contrast MRI (PC-MRI). RESULTS The size and localization of FM meningiomas do not significantly affect the CFS circulation parameters. Pyramidal symptoms, sensory disorders, and XIth cranial nerve dysfunction are correlated with the CFS circulation parameters. According to the preoperative PC-MRI data, the CFS circulation parameters in all FM meningioma patients were significantly higher than their normal values. Surgery was followed by a reduction in the peak positive velocity, negative peak velocity, and range of the maximum linear velocity amplitude. Positive and negative volumes and the stroke volume did not change. Recovery dynamics of the CFS circulation parameters was similar, regardless of surgery completeness. According to the PC-MRI data, the CFS circulation parameters did not reach normal values in all groups of operated patients. CONCLUSION The results of investigation of the CFS circulation in patients with FM meningiomas support the use of palliative surgery (partial resection, dural plasty, craniovertebral junction decompression) in the case of inoperable meningiomas.
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Affiliation(s)
| | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
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Casabella AM, Urakov TM, Basil G, Morcos JJ. Management of Foramen Magnum Meningioma During Pregnancy: Literature Review and Case Report. World Neurosurg 2017; 97:752.e15-752.e18. [DOI: 10.1016/j.wneu.2016.10.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
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Predictors of Acute Vertebrobasilar Vasospasm following Tumor Resection in the Foramen Magnum Region. PLoS One 2016; 11:e0163908. [PMID: 27682826 PMCID: PMC5040390 DOI: 10.1371/journal.pone.0163908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/18/2016] [Indexed: 02/05/2023] Open
Abstract
Objective Cerebral vasospasm can occur after skull base tumor removal. Few studies concentrated on the posterior circulation vasospasm after tumor resection in the posterior fossa. We aimed to identify the risk factors associated with postoperative vertebrobasilar vasospasm after tumor resection in the foramen magnum. Methods We retrospectively reviewed the data of 62 patients with tumors in the foramen magnum at our institution from January 2010 to January 2015. The demographic data, tumor features, surgical characteristics were collected. Vertebrobasilar vasospasm was evaluated by bedside transcranial Doppler before surgery and on postoperative day 1, 3, 7. Univariate and multivariate analyses were performed to determine the predictors of postoperative vasospasm in the posterior circulation. Results Vertebrobasilar vasospasm was detected in 28 (53.8%) of the 62 patients at a mean time of 3.5 days after surgery. There were 5 (8%) patients with severe vasospasm according to the grading criteria. Age, tumor type, tumor size, vertebral artery encasement, and surgical time were significantly related to vasospasm in the univariate analysis. Further multivariate analysis demonstrated that only age and vertebral artery encasement were independent risk factors predicting the occurrence of postoperative vertebrobasilar vasospasm. Conclusions The incidence of acute vertebrobasilar vasospasm is not uncommon after foramen magnum tumor resection. Age and vertebral artery encasement are significantly correlated with postoperative vasospasm. Close monitoring of vasospasm should be given to patients with younger age and the presence of vertebral artery encasement on the preoperative imaging to facilitate early diagnosis and intervention.
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Wu B, Chen LY, Huang GF, Liu WD. Disposal of Occipital Condyle in Far Lateral Approach for Ventrolateral Foramen Magnum Meningiomas. World Neurosurg 2016; 93:29-37. [DOI: 10.1016/j.wneu.2016.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/15/2016] [Accepted: 05/18/2016] [Indexed: 11/26/2022]
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GOTO T, OHATA K. Surgical Resectability of Skull Base Meningiomas. Neurol Med Chir (Tokyo) 2016; 56:372-8. [PMID: 27076382 PMCID: PMC4945595 DOI: 10.2176/nmc.ra.2015-0354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/11/2016] [Indexed: 12/11/2022] Open
Abstract
With recent advances in surgical technology such as preoperative imaging, neuro-monitoring, and surgical instruments, the surgical resectability of intracranial meningiomas has increased over the last two decades. This study reviewed clinical articles regarding the surgical treatment of meningiomas to clarify the role of surgical excision, with a focus on skull base meningiomas. We sub-classified clinical articles about skull base meningiomas into two categories (anterior and middle fossa meningiomas; and posterior fossa meningiomas) and reviewed papers in each category. In cases with anterior and middle fossa meningiomas, surgical resectability has reached a sufficient level to maximize functional preservation. In cases of posterior fossa meningioma, however, surgical respectability remains insufficient even with full use of recent surgical modalities. Continuous refining of operative procedures is required to obtain more satisfactory outcomes, especially for posterior fossa meningioma. In addition, recent long-term outcomes of stereotactic radiosurgery (SRS) were acceptable for controlling the skull base meningiomas. Therefore, combination with surgical excision and SRS should be considered in complicated skull base meningiomas.
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Affiliation(s)
- Takeo GOTO
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka
| | - Kenji OHATA
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka
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Choudhri O, Ravikumar VK, Gephart MH. Foramen Magnum Meningioma with Brainstem Compression During Pregnancy. World Neurosurg 2016; 91:671.e9-671.e12. [PMID: 27080233 DOI: 10.1016/j.wneu.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Meningiomas can present during pregnancy as the result of hormonal as well as fluid changes. Foramen magnum meningiomas are particularly rare. We present the first reported case successfully treated during pregnancy. CASE DESCRIPTION A 34-year-old female patient in her second trimester of pregnancy presented with a several-week history of neck pain, clonus, and right-sided upper extremity weakness. Magnetic resonance imaging of the brain demonstrated a 3.5-cm foramen magnum meningioma causing severe compression of the cervicomedullary junction. The patient underwent a far lateral craniotomy with successful decompression of the brainstem, resection of the tumor, and no permanent postoperative neurologic deficits. She made an excellent recovery and delivered a normal baby at 38 weeks with no complications. A small residual tumor engulfing the vertebral artery was treated with stereotactic radiosurgery 3 months postpartum. Diagnostic and treatment challenges unique to this case are discussed. CONCLUSIONS Large skull base tumors symptomatic in pregnancy can be safely treated with careful planning and close monitoring.
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Affiliation(s)
- Omar Choudhri
- Department of Neurosurgery, University of California, San Francisco, California, USA.
| | - Vinod K Ravikumar
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
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Dührsen L, Emami P, Matschke J, Abboud T, Westphal M, Regelsberger J. Meninigiomas of the Craniocervical Junction--A Distinctive Subgroup of Meningiomas. PLoS One 2016; 11:e0153405. [PMID: 27070421 PMCID: PMC4829216 DOI: 10.1371/journal.pone.0153405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Meningioma of the cranio-cervical junction is a rare diagnosis and demand a thorough surgical planning as radical excision of these tumors is difficult. In this context recurrence is most likely due to regrowth of residual tumor. The aim of this study was to evaluate the clinical course of patients operated for craniocervical meningioma (CCM) and to investigate the histological features of these tumors and their impact on recurrence rate. Methods All patients who were operated for CCM at our institution between 2003 and 2012 were identified. Presenting symptoms, MRI findings, surgical approaches and recurrence rate were reviewed retrospectively using medical charts. Histological features of the included tumors were studied focusing on subtypes and MIB-1 immunoreactivity and compared with MIB-1 immunoreactivity in an age and gender-matched control group of patients with supratentorial meningioma. Results 18 patients with CCM with a mean age of 56.2 years and median follow-up of 60 months were included in the study. Sensory or motor deficit was the most frequent presenting symptom followed by neck pain and lower cranial nerve palsy. Simpson grade II resection was achieved in 16 patients and Simpson grade III resection in two patients. Mortality, morbidity and recurrence rates were 16.7%, 5.5% and 5.5%, respectively. According to the WHO-grading all were found to be grade I meningiomas. Histological subtypes included meningotheliomatous (10), transitional (2), fibrillar (2), angiomatous (3) and secretory (1) meningioma. The mean MIB-1 labeling index in the study group was significantly higher than in the control group, (7.2% and 3.6%, respectively), p < 0.05. There was no correlation between MIB-1 levels and tumor recurrence. Conclusions CCM seems to have a benign character. Despite a significantly higher MIB-1 index, a high rate of recurrence was not observed. Therefore, approaches with high morbidity are not justified. Nevertheless, in view of the challenging approaches with limited access to the lesion, CCM should be considered a distinctive clinical subgroup.
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Affiliation(s)
- Lasse Dührsen
- Department of Neurosurgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Pedram Emami
- Department of Neurosurgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Matschke
- Institute of Neuropathology, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tammam Abboud
- Department of Neurosurgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Jurinovic P, Bulicic AR, Marcic M, Mise NI, Titlic M, Suljic E. Foramen Magnum Meningioma: a Case Report and Review of Literature. Acta Inform Med 2016; 24:74-7. [PMID: 27041817 PMCID: PMC4789635 DOI: 10.5455/aim.2016.24.74-77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/21/2016] [Indexed: 11/08/2022] Open
Abstract
Introduction: Meningiomas are slow-growing benign tumors that arise at any location where arachnoid cells reside. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms (14.3–19%), only 1.8 to 3.2% arise at the foramen magnum. Their indolent development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and diagnosis. Case report: We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction.
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Affiliation(s)
- Pavao Jurinovic
- Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
| | - Ana Repic Bulicic
- Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
| | - Marino Marcic
- Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
| | - Nikolina Ivica Mise
- Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
| | - Marina Titlic
- Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
| | - Enra Suljic
- Neurological Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
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Yu Y, Xu H, Wang Y, Zhao G. Papillary meningioma of the jugular foramen: A case report. Oncol Lett 2015; 10:3655-3659. [PMID: 26788186 DOI: 10.3892/ol.2015.3785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 03/09/2015] [Indexed: 11/06/2022] Open
Abstract
Papillary meningioma (PM) is a rare histological variant of intracranial meningioma, which displays an aggressive behavior and its management is difficult. The present study reported the case of a 21-year-old male patient, who presented with headaches and dizziness. Upon neurological examination, left hypoglossal nerve palsy and left cerebellar signs were observed. Computed tomography and magnetic resonance imaging scans of the brain revealed a high-density mass in the left jugular foramen area. Following an uneventful complete surgical resection of the tumor, a definitive diagnosis of Grade III PM was determined based on the histopathological findings, according to the World Health Organization classification. CT scanning one day after surgery confirmed that the tumor had been completely resected, and after four years of follow-up, no evidence of transformation or recurrence was observed.
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Affiliation(s)
- Ying Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Haiyang Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yubo Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Gang Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Della Puppa A, Rustemi O, Scienza R. The suboccipital midline approach to foramen magnum meningiomas: safety and efficacy in a series of 23 consecutive patients over a 5-year period. Acta Neurochir (Wien) 2015; 157:1275-6. [PMID: 25948080 DOI: 10.1007/s00701-015-2438-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Huang J, Dai M, Cheng C, Wu D, Jiang C, Zhou Z, Shao J. Far-lateral approach assisted by multimodal neuronavigation and electrophysiological monitoring technique for complex clival tumor. Br J Neurosurg 2015; 29:597-9. [PMID: 25816926 DOI: 10.3109/02688697.2015.1019419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Large clival meningiomas are a major surgical challenge with risks to life and permanent deficit. A 65-year-old man with a meningioma anterior to the medulla oblongata with brain stem compression was operated with far-lateral approach assisted by multimodal neuronavigation and neurophysiological monitoring techniques. Total resection of the tumor was achieved with no intra- or post-operative complications. This case illustrates the benefits obtained by a multimodal approach.
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Affiliation(s)
- Jin Huang
- a Department of Neurosurgery , Wuxi People's Hospital of Nanjing Medical University , Wuxi , P. R. China
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Das KK, Kumar R, Ashish K, Bettaswamy G, Mehrotra A, Jaiswal S, Sahu RN, Jaiswal AK, Behari S. Extramedullary foramen magnum tumors and their surgical management: An experience with 29 cases. Asian J Neurosurg 2015; 9:223-32. [PMID: 25685220 PMCID: PMC4323967 DOI: 10.4103/1793-5482.146616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Surgical management of foramen magnum (FM) tumors is challenging by virtue of their location and vital neurovascular relationships. The ideal approach to anterior/anterolateral tumors continue to evoke controversy even in the modern era. In this article, we present and discuss our experience in the surgical management of these tumors. Materials and Methods: This retrospective study includes 29 consecutive patients (mean age 36.6 years, M: F = 2.63:1) of extramedullary tumors at the surgical foramen magnum, operated at our center, between 2007 and 2012. Results: Their mean duration of symptoms was 14. 6 months. A majority of the patients presented with motor symptoms (quadri/paraparesis, n = 21, 72.4%), neck pain with/without suboccipital radiation (n = 16, 55.2%) and sensory symptoms like tingling/numbness (n = 16, 55.2%). There were nine extradural (31%) and 20 intradural tumors (69%). Most of the tumors were located posterolateral to the neuraxis (n = 13, 44.8%). Nerve sheath tumors (n = 11, 38%) and meningiomas (n = 5, 17.2%) were the most commonly encountered histologies in our series. The standard posterior approach was the most frequently employed surgical approach (n = 20, 69%). Operative mortality and morbidity were 3.4 and 18.9%, respectively. At a mean follow-up of 27.3 months, 13 out of the 18 available patients improved. Conclusion: A majority of the foramen magnum tumors are amenable to excision via the standard posterior approach. Small anterior dural-based meningiomas/recurrent tumors may require a lateral approach like the far lateral approach.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajan Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumar Ashish
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Guruprasad Bettaswamy
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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