Dhandapani Sivashanmugam, Negm Hazem M, Cohen Salomon, Anand Vijay K, Schwartz Theodore H
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh.
Department of Neurosurgery, Menoufia University.
Cureus. 2015 Aug 25;7(8):e311. doi: 10.7759/cureus.311.
Anterior cerebral artery (ACA) encasement is often considered a contraindication for an endonasal endoscopic transsphenoidal approach. We report a patient with a tuberculum sella meningioma with ACA encasement, in whom a gross total excision was achieved through an endonasal endoscopic transsphenoidal transtuberculum, transplanum approach. The tumor was sharply dissected along the left ACA using meticulous bimanual sharp dissection after internal decompression. Moreover, the medial optic canals were opened and the optic nerves decompressed. A gasket seal closure with a nasoseptal flap was performed, and the patient was discharged on postoperative day four with improved vision. This case highlights the ability to remove planum and tuberculum meningiomas with vascular encasement through an endonasal endoscopic approach with the potential for safe vascular dissection. The absence of luminal narrowing can be used to assure the likelihood of a safe arachnoid plane.
大脑前动脉（ACA）包绕通常被认为是鼻内镜经蝶窦入路的禁忌证。我们报告1例患有鞍结节脑膜瘤且伴有大脑前动脉包绕的患者，该患者通过鼻内镜经蝶窦经结节、经筛板入路实现了肿瘤全切。在肿瘤内减压后，采用精细的双手锐性分离沿左侧大脑前动脉将肿瘤锐性剥离。此外，打开内侧视神经管并对视神经进行减压。采用鼻中隔瓣进行垫片封闭缝合，患者术后第4天出院，视力改善。该病例突出了通过鼻内镜入路切除伴有血管包绕的筛板和结节脑膜瘤的能力以及安全进行血管分离的可能性。管腔无狭窄可用于确保存在安全蛛网膜平面的可能性。
