Primary meningiomas of the jugular fossa

2002 ◽  
Vol 97 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty
Keyword(s):  
Surgical Approach ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Length Of Hospital Stay ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Presenting Symptoms ◽  
Jugular Fossa ◽  
The Mean ◽  
Fine Print

Object. Primary jugular fossa meningomas (JFMs) are one of the rarest subgroups of meningioma, with fewer than 40 cases reported in the literature. The authors retrospectively analyzed the results of surgical treatment in their series of patients, including clinical, pathological, and complication features. The surgical approach was mandated by the pathological anatomy of the tumor as well as by the anatomy of the individual patient. Methods. During a 6.5-year period, the authors performed nine surgeries in eight patients (seven women [88%] and one man [12%]) with JFMs. Six lesions occurred on the right side and two on the left. The most common presenting symptoms were altered hearing in five patients (62%), swallowing difficulties in four patients (50%), and a deficit of the 11th cranial nerve in three patients (38%); a combination of two or more signs or symptoms was common. The surgical approach was tailored to the local anatomy (tumor—neurovascular relationships) found in each patient; three different routes were used. Radical tumor removal was achieved in all patients; one tumor recurrence occurred after 20 months in a patient in whom the tumor had displayed atypical histological features. This woman underwent a second operation. The mean length of hospital stay was 1 week. The mean and the median follow-up period were 45 and 40 months, respectively. The most common complications were transient lower cranial nerve deficits, which resolved or were compensated for in all patients within 1 month. Conclusions. With a careful, extensive preoperative evaluation and appropriate tailoring of the operative approach, JFMs can be radically resected with the expectation of good outcome.

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

2000 ◽  
Vol 93 (4) ◽  
pp. 586-593 ◽  
Author(s):  
Johann Romstöck ◽  
Christian Strauss ◽  
Rudolf Fahlbusch
Keyword(s):  
Detailed Analysis ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Procedure ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Fine Print

Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

Cerebellopontine angle meningiomas

1984 ◽  
Vol 60 (3) ◽  
pp. 500-505 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Peter J. Jannetta
Keyword(s):  
Computerized Tomography ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Mortality ◽  
Preoperative Evaluation ◽  
Content Type ◽  
Surgical Microscope ◽  
Fine Print

✓ During the years 1974 through 1981, 22 patients with cerebellopontine angle meningiomas underwent surgery: 14 tumors were excised completely, and eight subtotally. A retromastoid approach was used in 19 cases and a subtemporal approach in three cases. There was no operative mortality and the quality of survival was good. Five patients suffered new cranial nerve deficits as a result of the operation. The average follow-up period was 5 years. One tumor thought to be completely removed has recurred, but has not required another operation so far. One subtotally excised tumor required reoperation. Computerized tomography and arteriography were important in preoperative evaluation. Good neuroanesthesia, the use of the surgical microscope and microtechnique, and an understanding of the pathological relationships were factors contributing to good results.

Operative management of tumors involving the cavernous sinus

1986 ◽  
Vol 64 (6) ◽  
pp. 879-889 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Aage R. Møller
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Operative Procedure ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

Slitlike syrinx cavities: a persistent central canal

2002 ◽  
Vol 97 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Mr Imaging ◽  
Incidental Finding ◽  
Central Canal ◽  
Cervical Region ◽  
Imaging Features ◽  
Content Type ◽  
Presenting Symptoms ◽  
The Mean ◽  
Fine Print

Object. The authors review their experience in the diagnosis and management of 32 patients with slitlike syrinx cavities. Methods. There were 18 men and 14 women with a mean age of 40 years. Presenting symptoms that prompted magnetic resonance (MR) imaging evaluation were mechanical spinal pain (13 patients), radicular pain (seven patients), paresthesia (six patients), numbness (five patients), and muscle spasm (one patient). In 12 patients neurological examination demonstrated normal status, and in the remainder only minimal sensory or motor abnormalities were found. The mean diameter of the syrinx cavity was 2 mm (range 1–5 mm), and on average it covered three vertebral levels. The cavities were limited to the cervical region in 16 patients, the thoracic in 12, and both regions in four patients. The mean follow-up time for changes in clinical condition and repeated MR imaging features were 38 and 32 months, respectively. Thirty-one patients were treated nonoperatively, and one was treated surgically. During the follow-up period clinical improvement was documented in six patients, worsened status in seven, and no change was demonstrated in the clinical status of 19 patients. None of the syrinx cavities changed in size. In 16 patients medical workup revealed alternative diagnoses that were determined to be the true causes of each patient's symptoms. Conclusions. Slitlike cavities likely do not represent true syringomyelia but rather remnants of the central canal detected in a small percentage of adults. Review of the authors' experience indicates that these cavities are asymptomatic and are unlikely to change in size. They can be considered an incidental finding, and in many of these patients another condition explaining the patient's symptoms may be found.

Gamma knife surgery for intracranial cavernous hemangioma

2005 ◽  
Vol 102 ◽  
pp. 102-106 ◽  
Author(s):  
Moo Seong Kim ◽  
Se Young Pyo ◽  
Young Gyun Jeong ◽  
Sun Il Lee ◽  
Yong Tae Jung ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Gamma Knife ◽  
Cavernous Hemangioma ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Presenting Symptoms ◽  
Cavernous Hemangiomas ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to assess the benefits of radiosurgery for cavernous hemangioma. Methods. Sixty-five cavernous hemangiomas were treated with gamma knife surgery (GKS) between October 1994 and December 2002. Forty-two patients attended follow up. The mean patient age was 37.6 years (range 7–60 years). The lesions were located in the frontal lobe in 12 cases, deep in the parietal lobe in five, in the basal ganglia in five, in the temporal in three, in the cerebellum in three, in the pons/midbrain in six, and in multiple locations in eight cases. The presenting symptoms were seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78 Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after radiosurgery was 29.6 months (range 5–93 months). The tumor decreased in size in 29 cases, was unchanged in 12, and increased in size in one. In the seizure group, seizures were controlled without anticonvulsant medication in nine cases (81.8%) after 31.3 months (range 12–80 months). After 93 months, one patient developed a cyst, which was resected. Rebleeding occurred in one case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%), in three (7.1%) of which neurological deterioration was correlated with imaging changes. In other cases these deficits were temporary. Conclusions. The authors found that GKS was an effective treatment modality for cavernous hemangiomas, especially for those located within the brainstem, basal ganglia, or deep portions of the brain. It can reduce seizure frequency significantly although this takes time. In the group receiving a marginal dose below 15 Gy the patients fared better than when the dose exceeded 15 Gy.

Meningiomas of the clivus and apical petrous bone

1986 ◽  
Vol 65 (2) ◽  
pp. 160-167 ◽  
Author(s):  
Marc R. Mayberg ◽  
Lindsay Symon
Keyword(s):  
Cranial Nerve ◽  
Clinical Status ◽  
Surgical Techniques ◽  
Petrous Bone ◽  
External Carotid ◽  
Total Resection ◽  
Content Type ◽  
Presenting Symptoms ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ Between March, 1966, and June, 1985, 23 women and 12 men underwent partial or total resection of apical petrous or clivus meningiomas at The National Hospital for Nervous Diseases. Presenting symptoms were typically of long duration (mean 29 months) and consisted primarily of gait disturbance, headache, hearing loss, and facial pain. Cranial nerve deficits, especially affecting the fifth, seventh, and eighth nerves, were observed in nearly every patient. Tumor size, but not location, was generally associated with degree of preoperative disability. Plain skull films were usually unremarkable, but computerized tomography (CT) proved highly accurate in determining tumor location and size. A characteristic pattern of vascular displacement was seen on vertebral angiograms, although blood supply to the tumors was derived primarily from branches of the internal and external carotid arteries. Subtotal or total resection was undertaken in all cases; nine patients required adjunctive cerebrospinal fluid shunting procedures. Although surgical techniques evolved during the course of the 20-year study, a combined supra- and infratentorial approach proved a relatively safe and effective means of surgical treatment. New or worsened postoperative deficits, especially cranial nerve palsies, and complications in the immediate postoperative period frequently resulted in temporary deterioration of the clinical status during this period; the total operative mortality rate was 9%. Follow-up periods ranged up to 9 years; 70% of patients resumed an independent existence, and none is known to have required subsequent tumor surgery. The size of the lesion was the only significant factor in determining outcome. These data suggest that meningiomas of the clivus and apical petrous bone can be accurately diagnosed by CT and three-vessel angiography, and effectively treated by microsurgical resection.

Gamma knife surgery for intracranial cavernous hemangioma

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 102-106 ◽  
Author(s):  
Moo Seong Kim ◽  
Se Young Pyo ◽  
Young Gyun Jeong ◽  
Sun Il Lee ◽  
Yong Tae Jung ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Gamma Knife ◽  
Cavernous Hemangioma ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Presenting Symptoms ◽  
Cavernous Hemangiomas ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to assess the benefits of radiosurgery for cavernous hemangioma. Methods. Sixty-five cavernous hemangiomas were treated with gamma knife surgery (GKS) between October 1994 and December 2002. Forty-two patients attended follow up. The mean patient age was 37.6 years (range 7–60 years). The lesions were located in the frontal lobe in 12 cases, deep in the parietal lobe in five, in the basal ganglia in five, in the temporal in three, in the cerebellum in three, in the pons/midbrain in six, and in multiple locations in eight cases. The presenting symptoms were seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78 Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after radiosurgery was 29.6 months (range 5–93 months). The tumor decreased in size in 29 cases, was unchanged in 12, and increased in size in one. In the seizure group, seizures were controlled without anticonvulsant medication in nine cases (81.8%) after 31.3 months (range 12–80 months). After 93 months, one patient developed a cyst, which was resected. Rebleeding occurred in one case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%), in three (7.1%) of which neurological deterioration was correlated with imaging changes. In other cases these deficits were temporary. Conclusions. The authors found that GKS was an effective treatment modality for cavernous hemangiomas, especially for those located within the brainstem, basal ganglia, or deep portions of the brain. It can reduce seizure frequency significantly although this takes time. In the group receiving a marginal dose below 15 Gy the patients fared better than when the dose exceeded 15 Gy.

Ventral foramen magnum meningiomas

2000 ◽  
Vol 92 (1) ◽  
pp. 71-80 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
Muhammad Husain
Keyword(s):  
Cranial Nerve ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Extent Of Surgery ◽  
Prolonged Hospital ◽  
Fine Print

Object. Ventral foramen magnum meningiomas (VFMMs) are rare lesions that account for more than 3% of all meningiomas. These are among the most challenging of all meningiomas to treat. The authors comprehensively analyzed multiple features in a series of VFMMs. Methods. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum (mean follow-up period, 40 months) and underwent surgery via a transcondylar approach. Sixteen patients underwent surgery for the first time: 12 underwent gross-total (75%), two near-total (12.5%), and two subtotal (12.5%) tumor removal. The remaining two patients were treated for a recurrent tumor. After obtaining postoperative Karnofsky Performance Scale (KPS) scores at follow up, statistically significant improvement was demonstrated compared with the preoperative scores. The extent of surgery and higher preoperative KPS scores were variables that showed statistically significant favorable influence on outcome. Ninth and 10th cranial nerve deficits were the most common complications contributing to a prolonged hospital stay. There were no perioperative deaths. Four patients died during the follow-up period. The first patient died of multiple myeloma. The second patient, in whom surgery was performed to treat a recurrent tumor, died 3 years after the surgery of new tumor recurrence at the age of 80 years. The remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Conclusions. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with frequent but transient morbidity caused by lower cranial nerve deficits. Radical removal of a recurrent tumor provides a relatively long, stable postoperative course. In patients presenting with a low KPS score a poor prognosis is demonstrated, and early diagnosis and treatment are recommended to avoid it.

Surgical resection of third ventricle colloid cysts

1994 ◽  
Vol 81 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Adam I. Lewis ◽  
Kerry R. Crone ◽  
Jamal Taha ◽  
Harry R. van Loveren ◽  
Hwa-Shain Yeh ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Third Ventricle ◽  
Operating Time ◽  
Memory Loss ◽  
Length Of Hospital Stay ◽  
Content Type ◽  
Transcallosal Approach ◽  
Presenting Symptoms ◽  
Colloid Cysts ◽  
Fine Print

✓ It is still not determined which is the best surgical option for third ventricle colloid cysts. Since 1990, the authors have used a steerable fiberscope to remove colloid cysts in seven patients and have performed microsurgery via a transcallosal approach in eight patients. The two techniques were compared for operating time, length of hospital stay, incidence of complications, recurrence, and hydrocephalus, and days spent recuperating before return to work to determine if endoscopic removal of colloid cysts is a safe and effective alternative to microsurgery. Statistical analysis was adjusted for age, sex, and presenting symptoms. Microsurgical cases averaged 206 minutes of operating time whereas endoscopic cases averaged 127 minutes (p = 0.01). For combined days spent in the intensive care unit and on the ward, the patients averaged 9.5 days after microsurgery and 4 days after endoscopy (p = 0.05). Postoperative complications occurred in five of eight patients after microsurgery and in one of seven patients after endoscopy (p = 0.09); complications were transient and primarily related to short-term memory loss. In all patients, preoperative symptoms resolved and the cysts have not recurred. Postoperatively, one patient required a ventriculoperitoneal shunt after microsurgery but all patients were shunt-independent after endoscopy. Patients returned to work an average of 59 days after discharge following microsurgery compared with an average of 26 days after endoscopy (p = 0.05). Compared with transcallosal microsurgery for the removal of colloid cysts, these preliminary results show that a steerable endoscope reduced operating time and that patients spent fewer days in the hospital and returned to work sooner after endoscopy.

Extreme lateral transcondylar approach: technical improvements and lessons learned

1994 ◽  
Vol 81 (1) ◽  
pp. 49-59 ◽  
Author(s):  
Ramesh P. Babu ◽  
Laligam N. Sekhar ◽  
Donald C. Wright
Keyword(s):  
Vertebral Artery ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Cerebrospinal Fluid Leakage ◽  
Karnofsky Score ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
The Mean ◽  
Complex Lesions ◽  
Fine Print

✓ An extreme lateral transcondylar or extreme lateral transfacetal surgical approach was used to treat 22 patients with complex lesions over a 22-month period. The lesions included basilar invagination with vertebral artery pathology, giant aneurysm or arteriovenous fistula of the vertebral artery, meningioma, chordoma, chondrosarcoma, and paraganglioma. The approach was used alone or in combination with a presigmoid petrosal or subtemporal-infratemporal approach. Refinements of the operative technique, treatment strategies for complex lesions, and the avoidance of complications are discussed. Complications included cerebrospinal fluid leakage, meningitis, pseudomeningocele, hemiparesis or quadriparesis, lower cranial nerve deficits, and vertebral artery injury requiring repair. With treatment, major neurological deficits resolved completely in three patients and partially in two. There was no operative mortality, but four patients died during the follow-up period. For the 18 surviving patients, the mean preoperative and postoperative Karnofsky scores were 81 and 93, respectively. For the four who died, the mean preoperative Karnofsky score was 73 and the mean postoperative score was 63.

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