Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
World Neurosurg. 2024 Feb;182:43-44. doi: 10.1016/j.wneu.2023.11.033. Epub 2023 Nov 14.
Clinoidal meningiomas are meningiomas arising from or in the vicinity of the anterior clinoid process. Despite advanced microsurgical techniques, clinoidal meningiomas remain challenging. Extradural anterior clinoidectomy with optical unroofing remains an important tool in skull base surgery, which provides a safe operative corridor, facilitating greater extent of resection and enhancing overall outcome, particularly visual function. A 66-year-old woman presented with history of visual disturbances. Magnetic resonance imaging revealed a dural-based tumor consistent with a large left clinoidal meningioma, with tumor wrapping (encircling) around the left trunk and internal carotid artery (ICA) bifurcation, elevating the left middle cerebral artery M1 segment, and invading the left optic canal. Left cranio-orbital craniotomy with pretemporal exposure was used (Video 1). A high-speed diamond drill with irrigation completed the extradural anterior clinoidectomy and optical canal unroofing. Use of a 1-mm Kerrison rongeur should be done with utmost care. The tumor was unwrapped via meticulous piecemeal removal. Final dissection and ICA unwrapping was done when the tumor was debulked enough that dissecting it off the artery was safe and under less tension. Due to its obscurity, final decompression of the left optic nerve with incision and opening of the falciform ligament was performed at the end of the procedure. Postoperative neuro-ophthalmologic examination showed a grossly unchanged left visual field with some visual acuity improvement. Resection of tumor encircling the ICA has been described previously; however, to the best of our knowledge, this is the first video describing removal of a tumor surrounding the ICA (perfomed by senior author K.I.A.), essentially "unwrapping" the left ICA trunk and its bifurcation. The patient consented to publication.
颅眶沟通性脑膜瘤是起源于前床突或邻近前床突的脑膜瘤。尽管显微外科技术不断发展,颅眶沟通性脑膜瘤仍然是极具挑战性的。颅眶沟通性脑膜瘤切除术采用硬膜外前方床突切除术和视神经管减压术仍然是颅底手术中的重要工具,它提供了一个安全的手术通道,有助于更大程度的切除肿瘤,并提高整体预后,特别是视觉功能。一位 66 岁的女性因视力障碍就诊。磁共振成像显示一硬脑膜肿瘤,符合左侧大型颅眶沟通性脑膜瘤,肿瘤包裹(环绕)左侧颈内动脉主干和颈内动脉分叉处,抬高左侧大脑中动脉 M1 段,并侵犯左侧视神经管。采用经额颞部颅眶开颅术(视频 1)。高速钻石钻头冲洗完成硬膜外前方床突切除术和视神经管减压术。使用 1 毫米的 Kerrison 咬骨钳应格外小心。通过细致的分片切除来剥离肿瘤。当肿瘤足够缩小,从动脉上解剖下来是安全且张力较小的情况下,进行最终的解剖和颈内动脉松解。由于其位置隐蔽,在手术结束时进行左侧视神经的最终减压,切开和打开镰状韧带。术后神经眼科检查显示左眼视野大体不变,但视力稍有改善。以前曾描述过包裹颈内动脉的肿瘤切除术;然而,据我们所知,这是第一个描述切除环绕颈内动脉的肿瘤(由资深作者 K.I.A. 完成)的视频,基本上是“解开”左侧颈内动脉主干及其分叉。患者同意发表。
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