Modified unilateral approach for mid-third giant bifalcine meningiomas: resection using an oblique surgical trajectory and falx window

Karthigeyan, Madhivanan; Rajasekhar, Rekhapalli; Salunke, Pravin; Singh, Ashutosh

doi:10.1007/s00701-018-3770-y

Cited by 10 publications

(9 citation statements)

References 13 publications

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“…Unlike the removal of convex meningiomas, middle-third FMs are usually hidden deep under the overlying eloquent cortex and abundant bridging veins; this positioning can lead to great difficulty in resection because impairment of these vital cortices and veins can cause serious surgical complications [13,14]. Indeed, injury to the precentral gyrus can lead to contralateral hemiparesis; damage to the postcentral gyrus can cause contralateral paresthesia; impairment to the paracentral lobule can manifest as contralateral lower limb weakness, sensory loss, or bladder incontinence; and disruption to the major bridging veins can result in venous infarction [2,15]. Therefore, in recent years, some authors have reported a contralateral interhemispheric approach, which can avoid edema aggravation of the ipsilateral cerebral cortex and ipsilateral bridging vein injury and provides a direct trajectory to the tumor base, allowing for easier cutting of most of the tumor blood supply [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Falcine meningiomas (FMs) originating from the cerebral falx comprise approximately 5-9% of all intracranial meningiomas [1,2]. According to their relationship to the coronal and herringbone sutures, FMs can be classified into anterior, middle, and posterior third FMs [2]. Middle-third FMs are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Zhang

Wang

et al. 2023

Brain Sciences

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Middle-third falcine meningiomas (FMs) are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access. The endoscopic approach has the advantages of wide visualization and free visual axis without areas of visual blindness, which allows for the resection of FMs with good visualization in a narrow space, especially in deep operations. Here, we report a case of a middle-third FM treated using the endoscopic ipsilateral interhemispheric approach. A 55-year-old female who had suffered a headache for 6 months without other remarkable symptoms was diagnosed with middle-third FM combined with imaging evaluation. According to the imaging performance and anatomical features, we scheduled the endoscopic ipsilateral interhemispheric approach to access and remove the tumor. Consequently, gross total tumor resection was achieved without surgery-related complications. After the surgery, the patient had an uneventful recovery and was discharged with no neurological deficit. During the 24-month follow-up, the patient’s condition remained favorable, with no tumor recurrence. In our opinion, the endoscopic ipsilateral interhemispheric approach is a feasible surgical strategy for FMs, which deserves further exploration as a treatment option.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Zhang

Wang

et al. 2023

Brain Sciences

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“…In addition to the large meningioma in the frontal lobe, there was an additional meningioma in the occipital lobe. Although additional craniotomies have been used according to some reports, these additional craniotomies present a risk of prolonged operative time, sinus injury, and retraction injuries to the brain [ 29 , 30 ]. Hence, the bilateral extended rostrotentorial craniotomy—a wide bilateral single craniotomy from frontal bone to occipital bone—was planned for en bloc resection of the multiple meningiomas in this case.…”

Section: Discussionmentioning

confidence: 99%

Multiple Meningioma Resection by Bilateral Extended Rostrotentorial Craniotomy with a 3D-Print Guide in a Cat

Song

Lee²,

Jeong³

et al. 2022

Veterinary Sciences

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A 13-year-old castrated male domestic shorthair cat was referred for the surgical removal of multiple meningiomas. The cat experienced generalized tonic–clonic seizures, altered mentation, mild proprioceptive ataxia, and circling. Magnetic resonance imaging (MRI) revealed two round, solitary, well-delineated, space-occupying lesions suggestive of multiple meningiomas in the right frontal and occipital lobes. Before surgery, patient-specific three-dimensional (3D) printed models and guides were produced using a 3D program based on MRI and computed tomography (CT), and a rehearsal surgery was performed. With a 3D guide to find the location of the craniotomy lines, bilateral extended rostrotentorial craniotomy allowed en bloc resection of multiple meningiomas. The bone fragment was replaced and secured to the skull with a craniofacial plate and screws with an artificial dura. All of the surgical steps were performed without complications. The preoperative presenting signs were resolved by the time of follow-up examinations 2 weeks after surgery. Twelve months after the removal of the multiple meningiomas, the cat survived without further neurological progression. For the resection of multiple meningiomas, surgery can result in large bone defects and risk of massive hemorrhage. For this challenging surgery, patient-specific 3D models and guides can be effective for accurate and safe craniotomies.

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“…The clinical manifestations depend on their location and grade of their mass effect, but some tumors may grow over time without giving any clinical symptoms [ 3 ] and therefore debut with a considerable size [ 4 , 5 , 6 , 7 ]. Giant intracranial meningiomas (GIMs), defined as contrast-enhancing lesions with a maximum diameter of more than 5 cm, are uncommon and are usually considered arduous to resect totally with a poorer prognosis [ 8 , 9 , 10 , 11 , 12 , 13 ]. Further, GIMs are associated with different degrees of peritumoral brain edema (PBE) that represents one of the major causes of poorer prognosis [ 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie

et al. 2022

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Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.

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Modified unilateral approach for mid-third giant bifalcine meningiomas: resection using an oblique surgical trajectory and falx window

Cited by 10 publications

References 13 publications

Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Multiple Meningioma Resection by Bilateral Extended Rostrotentorial Craniotomy with a 3D-Print Guide in a Cat

The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie

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