Liu James K
Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.
Neurosurg Focus. 2016 Jan;40 Video Suppl 1:2016.1.FocusVid.15452. doi: 10.3171/2016.1.FocusVid.15452.
Large deep-seated meningiomas of the falcotentorial region present a formidable surgical challenge. In this operative video, the author demonstrates the combined bi-occipital suboccipital transsinus transtentorial approach for microsurgical resection of a large falcotentorial meningioma. This approach involves division of the less dominant transverse sinus after assessment of the venous pressure before and after clipping of the sinus with continuous neurophysiologic monitoring. Mild retraction of the occipital lobe and cerebellum results in a wide supra- and infratentorial exposure of extensive pineal region tumors. This video atlas demonstrates the operative technique and surgical nuances, including patient positioning, supra- and infratentorial craniotomy, transsinus transtentorial incision, and tumor removal with preservation of the vein of Galen complex. In summary, the combined bi-occipital suboccipital transsinus transtentorial approach provides a wide supra- and infratentorial surgical corridor for removal of select falcotentorial meningiomas. The video can be found here: https://youtu.be/3aD8h2uwBAo .
幕上下型深部大型脑膜瘤的手术极具挑战性。在本手术视频中，作者展示了双枕下经窦幕下经小脑幕入路，用于显微手术切除大型幕上下型脑膜瘤。该入路包括在连续神经生理监测下，评估夹闭横窦前后的静脉压力后，切断优势较小的横窦。轻度牵拉枕叶和小脑可广泛暴露幕上和幕下的松果体区肿瘤。本视频图谱展示了手术技术和手术细节，包括患者体位、幕上和幕下开颅、经窦幕下切口以及在保留大脑大静脉复合体的情况下切除肿瘤。总之，双枕下经窦幕下经小脑幕联合入路为切除特定的幕上下型脑膜瘤提供了一个宽阔的幕上和幕下手术通道。视频链接如下：https://youtu.be/3aD8h2uwBAo 。
