Gallardo-Ceja David, Sanchez-Correa Thalia E, Mendez-Rosito Diego
Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.
Oper Neurosurg. 2020 Jul 1;19(1):E49. doi: 10.1093/ons/opz290.
We describe the case of a 42-yr-old female patient with a 2-yr history of headache that has progressively worsened. Physical examination revealed no neurological deficit. Magnetic resonance imaging showed a large tumor of the left lesser sphenoid wing that enhanced with gadolinium and produced displacement of the midline and the Sylvian fissure. A thorough analysis of the origin of the tumor was done to establish the surgical strategy. With the patient positioned supine with the head slightly turned to the right side, fixed in a 3-pin head clamp, a pterional craniotomy was performed. Since the origin of the tumor is in the lesser wing an early extradural devascularization of the tumor was done with drilling out all the hyperostotic bone of the lesser sphenoid wing, including the lateral base of the anterior clinoid process. Intradural debulking and resection showed the effect of extradural devascularization with an important decrease in bleeding, allowing the total resection of the tumor. An immediate postop magnetic resonance showed a complete removal of the tumor. The patient presented a paresis of the oculomotor nerve that completely resolved in the 3-mo follow-up. In the following video illustration, we narrate this operative case and highlight the nuances of this approach.1 The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.
我们描述了一名42岁女性患者的病例，该患者有2年头痛病史，且病情逐渐加重。体格检查未发现神经功能缺损。磁共振成像显示左侧蝶骨小翼有一个大肿瘤，钆增强扫描显示该肿瘤有强化，并导致中线和大脑外侧裂移位。为制定手术策略，对肿瘤的起源进行了全面分析。患者仰卧位，头部稍向右侧转动，用三钉头夹固定，然后进行翼点开颅手术。由于肿瘤起源于蝶骨小翼，早期通过钻除蝶骨小翼所有增生骨，包括前床突外侧基部，进行了硬膜外肿瘤去血管化。硬膜内肿瘤减容和切除显示了硬膜外去血管化的效果，出血明显减少，从而得以完整切除肿瘤。术后即刻磁共振成像显示肿瘤已完全切除。患者出现动眼神经麻痹，在3个月的随访中完全恢复。在以下视频演示中，我们讲述这个手术病例，并突出这种手术方法的细微之处。1患者已同意发布视频、图像或临床或基因信息。
