Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum

Miller, E. B.; Crockard, H A

doi:10.1097/00006123-198706000-00026

Cited by 34 publications

(12 citation statements)

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“…In contrast to other skull base approaches, such as anterior, anterolateral, and posterolateral routes, which are routinely described for accessing extraaxial lesions ventral to the brainstem, 3,7,8,15,23,24,27,28,36,41,43,49,52,53,56,[59][60][61][62]64 the endonasal approach to the clival area has been used historically only to remove clival chordomas. 13,39,45,46 The bone destruction related to the chordoma often creates the surgical pathway, and its location is often purely anterior, making the transsphenoidal approach less difficult.…”

Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

“…As a result of these advantages it offers a lower morbidity and mortality rate when compared with transcranial procedures, and this also naturally leads to a shorter hospital stay. Nevertheless, a variety of innovative skull base approaches (including anterior, anterolateral, and posterolateral routes, which often require extensive neurovascular manipulation to gain access to the lesion) have been developed to allow resection of extraaxial lesions of the anterior skull base or lesions ventral to the brainstem 3,7,8,15,18,[20][21][22][23][24][26][27][28]36,41,43,49,52,53,56,[59][60][61][62]64 that are outside of the sella or immediate parasellar area. These approaches have often been used alone or in combination as staged approaches for extensive tumors.…”

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confidence: 99%

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Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

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Object The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable. Conclusions The major potential advantage of the endoscopic endonasal approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an anteromedial approach. Potential disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with cerebrospinal fluid (CSF) leakage and potential for meningitis resulting. These approaches often require a large opening of the dura mater over the tuberculum sellae and posterior planum sphenoidale, or retroclival space. In addition, they typically involve large intraoperative CSF leaks, which necessitate precise and effective dural closure.

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Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

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“…16,17) The transoral approach has been advocated to provide direct access to the craniocervical junction, but has serious limitations in cases of laterally spreading lesions and also carries the risk of contaminating the operative field, thus causing destabilization of the craniocervical junction. 3,9) We found that the lateral approach is therefore more advantageous for treating tumors in this region.…”

Section: Discussionmentioning

confidence: 95%

Transcondylar Fossa Approach to Treat Ventral Foramen Magnum Meningioma. Case Report.

Tange¹,

Uto²,

Wachi³

et al. 2001

Neurol. Med. Chir.(Tokyo)

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A 41-year-old female presented with a meningioma of the craniocervical junction manifesting as tetraparesis and vesicourethral dysfunction. Neuroradiological examinations showed a homogeneous enhanced mass lesion extending from the foramen magnum to the upper aspect of the second vertebral body. The tumor was totally removed via the transcondylar fossa approach, which is one type of the lateral approach. She was discharged without neurological deficits. The transcondylar approach is often utilized for lesions that occupy the ventral portion around the foramen magnum. The transcondylar fossa approach, a variation of the transcondylar approach, is a refined technique which obtains a closely similar surgical working field. Use of the transcondylar fossa approach remains controversial when treating patients with little brain stem dislocation, a small condylar fossa, and a protruding occipital condyle, but the approach can easily be converted to the transcondylar approach. The transcondylar fossa approach could become a standard method to access the craniocervical junction.

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“…A principal causa de re s s e cção subtotal dos tumores foi a aderência do tumor aos vasos e nervos cranianos, e não devida ao tipo de exposição. Também foi descrita a via trans-oral para abordagem destes tumores, quando situados e n t re as duas artérias vertebrais, mas esta técnica não tem sido utilizada pelo risco de fístula liquórica 20 .…”

Section: Discussionunclassified

Meningiomas anteriores e antero-laterais do forame magno

Tella

Neto

Aguiar

et al. 2006

Arq. Neuro-Psiquiatr.

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Relatamos nossa experiência com 11 pacientes portadores de meningiomas do forame magno, oito cranioespinhais e três espinocraniais. A média de idade foi 50,8 anos, o sintoma mais comum foi cefaléia occipital com duração média de 18,6 meses. Os principais achados neurológicos foram tetraparesia e comprometimento dos nervos cranianos baixos. O tratamento foi cirúrgico, sempre com exposição da artéria vertebral em sua entrada na dura-máter da fossa posterior e ressecção de parte do côndilo occipital apenas em três casos. Ressecção total foi possível em sete pacientes e parcial nos demais, devido às aderências a vasos e nervos. O prognóstico esteve relacionado com as condições neurológicas pré-operatórias.

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Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum

Cited by 34 publications

References 0 publications

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Transcondylar Fossa Approach to Treat Ventral Foramen Magnum Meningioma. Case Report.

Meningiomas anteriores e antero-laterais do forame magno

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