翼点开颅术切除伴气化前床突的蝶骨嵴脑膜瘤:二维手术视频。
Pterional Craniotomy for Resection of Clinoidal Meningioma Associated With an Aerated Anterior Clinoid Process: 2-Dimensional Operative Video.
机构信息
Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.
Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
出版信息
Oper Neurosurg (Hagerstown). 2020 Feb 1;18(2):E43. doi: 10.1093/ons/opz105.
Extradural removal of the clinoid performed prior to resection of clinoidal meningiomas has been advocated as a way to facilitate devascularization of the tumor and provide early identification and/or decompression of adjacent neurovascular structures. A small number of video publications exist in the literature that provides useful guidance to surgeons preparing for resection of clinoidal region meningiomas.1-3 However, none of these videos portray the variable anatomy associated with an aerated clinoid process. This known anatomical variant can increase the risk profile associated with resection of clinoidal meningomas-especially with regards to postoperative cerebrospinal fluid (CSF) fistula. In this video publication, we discuss the care of a 54 yr-old male who presented with visual deterioration in the right eye. Magnetic resonance imaging (MRI) revealed findings consistent with a right clinoidal meningioma. Computed tomography demonstrated bilateral aeration of the anterior clinoid processes. The patient was taken to the operating room for right pterional craniotomy for resection of the neoplasm. Edited, intraoperative 2-dimensional-video demonstrates the variable anatomy encountered during removal of an aerated clinoid process. Relevant steps associated with subsequent tumor resection are summarized. Following resection, MRI obtained in the early postoperative period demonstrated gross total resection of the neoplasm without untoward finding. The patient noted marked improvement in his vision following surgery and did not suffer any complications relating to postoperative CSF fistula. Full patient consent for photography and/or recording of other forms of video/imaging was obtained in the preoperative period.
在切除岩骨斜坡脑膜瘤之前进行硬膜外切除,被认为是一种使肿瘤血管化并早期识别和/或减压邻近神经血管结构的方法。文献中有少量关于视频出版物,为准备切除岩骨斜坡脑膜瘤的外科医生提供了有用的指导。1-3 然而,这些视频都没有描述与充气岩骨过程相关的可变解剖结构。这种已知的解剖变异会增加与切除岩骨斜坡脑膜瘤相关的风险-特别是与术后脑脊液(CSF)瘘相关的风险。在本视频出版物中,我们讨论了一名 54 岁男性的护理情况,该男性右眼视力恶化。磁共振成像(MRI)显示符合右侧岩骨斜坡脑膜瘤的发现。计算机断层扫描显示双侧前岩骨空气化。患者被送往手术室进行右侧翼点开颅术切除肿瘤。编辑后的术中二维视频显示了在切除充气岩骨过程中遇到的可变解剖结构。总结了与随后肿瘤切除相关的相关步骤。切除后,早期术后获得的 MRI 显示肿瘤大体全切除,无不良发现。患者术后视力明显改善,无术后 CSF 瘘相关并发症。在术前获得了患者对摄影和/或其他形式的视频/成像记录的完全同意。