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Minimally invasive nummular approach to a giant meningioma of the anterior fossa

BACKGROUND: Several approaches are described for giant meningiomas of the anterior skull base. Recently, endonasal endoscopic approaches have been described as a minimally invasive (MI) alternative. However, the extension of dissection of the nose cavity and the risks of CSF leak do not fit in the M...

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Autores principales: Mandel, Mauricio, Correa Bastianon Santiago, Raphael Augusto, da Silva, Igor Araújo Ferreira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168338/
https://www.ncbi.nlm.nih.gov/pubmed/35673653
http://dx.doi.org/10.25259/SNI_1246_2021
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author Mandel, Mauricio
Correa Bastianon Santiago, Raphael Augusto
da Silva, Igor Araújo Ferreira
author_facet Mandel, Mauricio
Correa Bastianon Santiago, Raphael Augusto
da Silva, Igor Araújo Ferreira
author_sort Mandel, Mauricio
collection PubMed
description BACKGROUND: Several approaches are described for giant meningiomas of the anterior skull base. Recently, endonasal endoscopic approaches have been described as a minimally invasive (MI) alternative. However, the extension of dissection of the nose cavity and the risks of CSF leak do not fit in the MI prerogatives. We present an operative video illustrating a MI transcortical approach through a nummular craniotomy for a giant meningioma of the anterior fossa. CASE DESCRIPTION: We report an 83-year-old female patient. On neurological examination, she was drowsy and hemiparetic on the left side. MRI scan demonstrated a giant anterior fossa lesion (7.6 × 6.2 × 6 cm). An 1.5 diameter craniotomy was placed in the right frontal region after MRI 3D reconstruction analysis. The first step was to debulk the core of the tumor with the ultrasonic aspirator. An important aspect is that the surgeon needs to rotate its positions around the patient in a 360° fashion for a total resection. The final step was to inspect the surgical cavity with the endoscope to check for any remaining tumor. The patient was discharged home 1 day after the surgery with no new deficits. CONCLUSION: Giant meningiomas of the anterior fossa are a different entity. When they reach the cortical surface, the surgical approach can be different from the common skull base meningiomas. We demonstrate that a MI transcortical approach can be a safe alternative for giant meningiomas, especially for high-risk patients, as the elderly ones.
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spelling pubmed-91683382022-06-06 Minimally invasive nummular approach to a giant meningioma of the anterior fossa Mandel, Mauricio Correa Bastianon Santiago, Raphael Augusto da Silva, Igor Araújo Ferreira Surg Neurol Int Video Abstract BACKGROUND: Several approaches are described for giant meningiomas of the anterior skull base. Recently, endonasal endoscopic approaches have been described as a minimally invasive (MI) alternative. However, the extension of dissection of the nose cavity and the risks of CSF leak do not fit in the MI prerogatives. We present an operative video illustrating a MI transcortical approach through a nummular craniotomy for a giant meningioma of the anterior fossa. CASE DESCRIPTION: We report an 83-year-old female patient. On neurological examination, she was drowsy and hemiparetic on the left side. MRI scan demonstrated a giant anterior fossa lesion (7.6 × 6.2 × 6 cm). An 1.5 diameter craniotomy was placed in the right frontal region after MRI 3D reconstruction analysis. The first step was to debulk the core of the tumor with the ultrasonic aspirator. An important aspect is that the surgeon needs to rotate its positions around the patient in a 360° fashion for a total resection. The final step was to inspect the surgical cavity with the endoscope to check for any remaining tumor. The patient was discharged home 1 day after the surgery with no new deficits. CONCLUSION: Giant meningiomas of the anterior fossa are a different entity. When they reach the cortical surface, the surgical approach can be different from the common skull base meningiomas. We demonstrate that a MI transcortical approach can be a safe alternative for giant meningiomas, especially for high-risk patients, as the elderly ones. Scientific Scholar 2022-05-06 /pmc/articles/PMC9168338/ /pubmed/35673653 http://dx.doi.org/10.25259/SNI_1246_2021 Text en Copyright: © 2022 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Video Abstract
Mandel, Mauricio
Correa Bastianon Santiago, Raphael Augusto
da Silva, Igor Araújo Ferreira
Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title_full Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title_fullStr Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title_full_unstemmed Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title_short Minimally invasive nummular approach to a giant meningioma of the anterior fossa
title_sort minimally invasive nummular approach to a giant meningioma of the anterior fossa
topic Video Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168338/
https://www.ncbi.nlm.nih.gov/pubmed/35673653
http://dx.doi.org/10.25259/SNI_1246_2021
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