Commentary: Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Evan Luther ◽  
Gurvinder Kaur ◽  
Ricardo Komotar ◽  
Michael E Ivan
Keyword(s):  
Skull Base ◽  
Skull Base Meningioma ◽  
Microsurgical Resection

Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael A Mooney ◽  
Walid Ibn Essayed ◽  
Mohammad Ali Aziz-Sultan ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Hybrid Approach ◽  
Vascular Tumor ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Skull Base Tumors ◽  
Selective Embolization ◽  
Skull Base Meningioma ◽  
Microsurgical Resection

Abstract Some skull base tumors can be extremely hypervascular, incorporating multiple vascular territories and demonstrating arteriovenous shunting. Devascularization is a critical step undertaken early in meningioma surgery, necessary before the debulking that is required in skull base tumors. While devascularization can often be achieved with appropriate approach selection, bony drilling, and microsurgical cautery, preoperative embolization of meningiomas has an invaluable role in selected cases.1,2  Embolization, however, does have added risk, magnified in large tumors by the potential infarction with subsequent edema that can potentially lead to acute deterioration and neurosurgical emergency. Hence, to achieve devascularization of an extremely vascular tumor, embolization and surgical resection should be performed concomitantly, as one operation, in which embolization might be the first stage, or might be performed after the craniotomy flap is raised, if necessary.3 Naturally, this requires the multifaceted neurosurgical expertise of embolization and microsurgical resection, and the facility to perform such.  We present a case of a giant, hypervascular, radiation-induced, skull base meningioma with internal and external carotid artery supply in a young patient with deteriorating vision in his only eye. Selective embolization of the internal maxillary, middle meningeal, and middle cerebral artery blood supplies was performed. Microsurgical interruption of the ethmoidal artery blood supply was then performed. This hybrid approach safely and effectively devascularized the tumor and allowed for a complete resection of this high-risk tumor4 while minimizing risk to the ophthalmic artery and optic nerve.  The patient was consented for surgery.

scholarly journals Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

2021 ◽  
Author(s):  
Keiichi Takehana ◽  
Daisuke Nakamura ◽  
Alshaymaa Abdelghaffar ◽  
Megumi Uto ◽  
Tomohiro Katagiri ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Tumor Response ◽  
Fractionated Stereotactic Radiotherapy ◽  
Skull Base Meningioma ◽  
Skull Base Meningiomas ◽  
Simple Indicator ◽  
Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

SKULL BASE MENINGIOMA IN CHILDHOOD

2008 ◽  
Vol 5 (1) ◽  
pp. A3-A3
Author(s):  
T.C. Tan ◽  
H.M. Chiu ◽  
K.L. Man ◽  
Y.W. Tsang ◽  
C.M. Chan ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Meningioma

Patterns of skull base meningioma progression after failed radiosurgery

2007 ◽  
Vol 106 (1) ◽  
pp. 30-35 ◽  
Author(s):  
William T. Couldwell ◽  
Chad D. Cole ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Growth Patterns ◽  
World Health ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Surgical Removal ◽  
Skull Base Meningioma ◽  
Number Of Patients ◽  
Health Organization

Object Stereotactic radiosurgery has been reported to be an effective alternative to surgical removal of small to medium benign meningiomas as well as an adjuvant treatment modality to reduce the risk of tumor progression after subtotal resection. Its efficacy has been proved by excellent short-term radiosurgically demonstrated control rates, which have been reported to approach or exceed 90% in many contemporary studies involving the use of either linear accelerator–based systems or the Gamma Knife. Little is known, however, regarding the growth patterns of meningiomas that fail to stabilize after radiosurgery. Methods The authors report 13 cases of benign skull base meningiomas (World Health Organization Grade I) that demonstrated progression after radiosurgical treatment as a primary or an adjuvant therapy. Several tumors demonstrated rapid growth immediately after radiosurgical treatment, whereas other lesions progressed in a very delayed manner in some patients (up to 14 years after treatment). Regardless of the interval after which it occurs, tumor growth can be quite aggressive once it has begun. Conclusions Skull base meningioma growth can be aggressive after failed radiosurgery in some patients, and treatment failure can occur at long intervals following treatment. Special attention must be devoted to such significant occurrences given the increasing number of patients undergoing stereotactic radiosurgery for benign tumors, and careful extended (> 10 years) follow up must be undertaken in all patients after radiosurgery.

Occurrence of pituitary hormone deficits in relation with both pituitary and hypothalamic doses after radiotherapy for skull base meningioma

2021 ◽  
Author(s):  
Eléonore Partoune ◽  
Maxime Virzi ◽  
Loïc Vander Veken ◽  
Laurette Renard ◽  
Dominique Maiter
Keyword(s):  
Skull Base ◽  
Pituitary Hormone ◽  
Skull Base Meningioma
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