Balașa Adrian, Gyorki Gabriel, Tamas Flaviu, Hurghis Corina, Chinezu Rares
Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Tîrgu Mureș, Tîrgu Mureș, Romania.
Department of Neurosurgery, Tîrgu Mureș County Clinical Emergency Hospital, Tîrgu Mureș, Romania.
J Neurol Surg B Skull Base. 2021 Feb;82(Suppl 1):S33-S34. doi: 10.1055/s-0040-1714403. Epub 2020 Dec 31.
This study was to demonstrate surgical technique for an anterolateral foramen magnum meningioma. Present study is presented through an operative video. This study is conducted at the Department of Neurosurgery, Tîrgu Mureș, Romania. A 62-year-old female is the participant who was diagnosed with a foramen magnum meningioma. Complete surgical resection of the tumor with no postoperative deficits or complications. A 62 years-old female was admitted for left hemilingual atrophia, dysphonia, right hemiparesis grade 2 of 5, right hemihypesthesia, and cervical pain. The magnetic resonance imaging (MRI) showed a right foramen magnum meningioma, sized approximately 2 cm in all planes ( Fig. 1 ). This was classified with the Bernard system as an intradural foramen magnum meningioma with anterolateral insertion to the dura mater and below the vertebral artery. A suboccipital, retrocondylar, and c1 right hemilaminectomy approach was performed. Using microsurgical tumoral decompression techniques, ultrasonic aspiration, and following the natural cleavage planes, complete tumor removal was achieved ( Fig. 2 ). The patient presented an uneventful postoperative course with no postoperative new neurological deficits and was discharged at home 7 days following surgery. Control MRI at 6 months ( Fig. 1 ) and 2 years showed no tumor residue or recurrence. Neurologic status at 6 months was excellent, showing complete remission of symptoms. Retrocondylar suboccipital approach is a safe and feasible option for anterolateral foramen magnum meningiomas provided that natural corridors and dynamic retraction are used. The link to the video can be found at: https://youtu.be/jpxMcjCpN6E .
本研究旨在展示枕骨大孔前外侧脑膜瘤的手术技巧。本研究通过手术视频展示。本研究在罗马尼亚特尔古穆列什神经外科进行。一名62岁女性参与其中，被诊断为枕骨大孔脑膜瘤。肿瘤实现了完全手术切除，术后无神经功能缺损或并发症。一名62岁女性因左侧半舌萎缩、发音障碍、右侧偏瘫5级中的2级、右侧半身感觉减退和颈部疼痛入院。磁共振成像（MRI）显示右侧枕骨大孔脑膜瘤，各平面大小约2厘米（图1）。根据伯纳德系统，该肿瘤被分类为硬脊膜内枕骨大孔脑膜瘤，前外侧附着于硬脑膜且位于椎动脉下方。采用枕下、髁后和C1右侧半椎板切除术入路。使用显微手术肿瘤减压技术、超声吸引，并沿着自然解剖间隙，实现了肿瘤的完全切除（图2）。患者术后恢复顺利，无术后新的神经功能缺损，术后7天出院。术后6个月（图1）和2年的对照MRI显示无肿瘤残留或复发。6个月时神经功能状态良好，症状完全缓解。对于枕骨大孔前外侧脑膜瘤，髁后枕下入路是一种安全可行的选择，前提是利用自然通道并采用动态牵拉。视频链接可在：https://youtu.be/jpxMcjCpN6E 找到。
