Sayyahmelli Sima, Sun Zhaoliang, Avci Emel, Başkaya Mustafa K
Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.
J Neurol Surg B Skull Base. 2021 May 17;83(Suppl 3):e650-e652. doi: 10.1055/s-0041-1729996. eCollection 2022 Aug.
Anterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively. The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection ( Figs. 1 and 2 ). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up. This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors. The link to the video can be found at https://youtu.be/vt3o1c2o8Z0.
前床突脑膜瘤（ACMs）仍然是神经外科的一项重大挑战。颅底手术技术，包括在手术早期进行的硬膜外前床突切除术和视神经管减压术，有利于提高切除范围，从而改善整体预后，尤其是视觉功能。此外，当前床突脑膜瘤包裹神经血管结构，特别是床突上段颈内动脉及其分支时，会进一步增加手术并发症并降低切除范围。尽管在肿瘤完全包裹或导致动脉狭窄的情况下仍有可能从动脉壁上切除肿瘤，但肿瘤能否安全地与动脉壁分离最终必须在术中做出决定。患者为一名75岁女性，右侧视力进行性下降。神经系统检查发现，她右眼仅有光感，左眼无任何视力或周边视野丧失。磁共振成像（MRI）显示右侧前床突有一均匀强化肿块，包裹并压迫床突上段颈内动脉（ICA）。计算机断层扫描（CT）血管造影显示右侧床突上段ICA轻度狭窄，伴有360度包裹。决定采用翼点入路，行硬膜外前床突切除术和视神经管减压术。手术及术后过程顺利。MRI证实肿瘤全切（图1和图2）。组织病理学检查为脑膜内皮型脑膜瘤，世界卫生组织（WHO）I级。患者恢复良好，无任何复发迹象，在15个月的随访中视力有所改善。本视频展示了切除这些具有挑战性肿瘤的显微颅底手术技术的重要步骤。视频链接可在https://youtu.be/vt3o1c2o8Z0找到。
