Dataset Information

The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas.

ABSTRACT:

Background

The supracerebellar transtentorial (SCTT) approach has been established as a safe corridor to access the posteriomedial basal temporal region. Previous reports have demonstrated the efficacy of this route in the resection of intrinsic tumors and small arteriovenous malformations. Only one report in the English literature has described its use to resect a medial tentorial meningioma.

Methods

The authors discuss the relevant surgical anatomy of this approach and its advantages compared with more traditional routes, and illustrate its application to remove medial tentorial meningiomas through two operative cases with accompanying videos.

Results

In illustrative case one, the patient recovered from surgery with no deficits. All his preoperative symptoms had resolved at 3-month follow-up. At the 4-year follow-up, MRI did not demonstrate any growth of the residual tumor. In case two, gross total resection was achieved and the patient did not suffer any postoperative language or visual deficit. At 2-year follow-up, no tumor recurrence was present.

Conclusion

The SCTT approach has a potential to safely access extra-axial lesions located around the medial tentorial incisura. As demonstrated in these two cases, the approach merits consideration in patients with tentorial meningiomas as an alternative to more widely utilized skull base approaches and subtemporal routes.

SUBMITTER: Ansari SF

PROVIDER: S-EPMC3994713 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas.

Ansari Shaheryar F SF Young Ronald L RL Bohnstedt Bradley N BN Cohen-Gadol Aaron A AA

Surgical neurology international 20140315

<h4>Background</h4>The supracerebellar transtentorial (SCTT) approach has been established as a safe corridor to access the posteriomedial basal temporal region. Previous reports have demonstrated the efficacy of this route in the resection of intrinsic tumors and small arteriovenous malformations. Only one report in the English literature has described its use to resect a medial tentorial meningioma.<h4>Methods</h4>The authors discuss the relevant surgical anatomy of this approach and its advan ...[more]

PMID: 24778923

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Project description:IntroductionThe management of retroinfundibular craniopharyngioma (CP) remains the ultimate challenge for both transsphenoidal and open transcranial surgery because of their anatomical location and proximity to vital neurovascular structures. In this report, we aim to describe the technique and feasibility of a novel approach, the purely endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA), for resection of retroinfundibular CP.Case descriptionA 63-year-old women presented with progressive visual disturbance, polyuria, and spiritlessness of a 3-month duration. Imaging studies revealed a typical retroinfundibular CP containing solid and cystic components with calcification, which extended inferiorly in front of the brainstem and upward into the third ventricle. The EF-SCITA approach was attempted for resection of the tumor. During surgery, lateral prone positioning with upper flexion of the head and early CSF release allowed for download retraction of the cerebellum. This, in combination with tentorium incision, created a working corridor toward retrosellar and suprasellar spaces. This approach required working between neurovascular structures in the crural cistern, with tumor removal permitted in supra-oculomotor and infra-oculomotor spaces. After aspiration of the fluid contents through the supra-oculomotor triangle, the solid lesion was found tightly adhering to the distal part of the pituitary stalk, and subtotal resection was achieved for maintaining the integrity of pituitary function. In the immediate postoperative period, the patients exhibited oculomotor paralysis and was discharged with hormonal replacement therapy three weeks after operation. At her three-month follow-up appointment, she reported obvious vision improvement. Physical examinations showed partial alleviation of oculomotor paralysis. Pathological analyses confirmed the diagnosis of papillary CP.DiscussionThe purely EF-SCITA approach combines the advantages of both the posterolateral approach and endoscopic technique, which offers access to retrosellar and suprasellar spaces with seemingly low risks of postoperative morbidity. It would be a safe and effective alternative for the treatment of retroinfundibular CP, especially those with lateral extension to the temporal lobe or posterolateral extension to the petroclival region. Further observational studies in a larger cohort are urgently needed to assess the long-term efficacy of this minimal access approach.

Project description:Infiltration of adjacent dura with meningioma cells is a common phenomenon. Wide resection of the dural tail (DT) to achieve a gross total resection is a general recommendation. We aimed to investigate a tumor cell infiltration of the DT after image-guided resection of convexity meningiomas. The study's inclusion criteria were the diagnosis of convexity meningioma, planned Simpson I° resection, and an identifiable DT. Intraoperative image-guidance was applied to identify the outer edge of the DT and to guide resection. After resection, en-bloc specimen or four samples of outermost pieces of DT in case of piecemeal resection were sent for histological analysis. In addition to resection margin infiltration, the radiological extent of DT, radiomic characteristics (109 in total), histology, and demographic data were assessed. Hierarchical clustering was used to generate patient clusters for radiomic analysis. Twenty-two patients were included in the study, while 20 (91%) were female. The mean age was 54.2 (Standard deviation (SD) 13.9, range 30-85) years. En-bloc resection could be achieved in 4 patients. The remaining patients received piecemeal resection. 2 DT samples were omitted due to tumor infiltration of the superior sagittal sinus. None of the en-bloc resection samples demonstrated dural infiltration on the resection margin. Tumor cells were detected in 4 of 70 (5.7%) dural tail samples and could not be excluded in another 5 of 70 (7.1%). No tumor recurrences were detected at follow-up MRI examinations after a mean follow-up of 27.5 (SD 13.2, range 0 to 50.0) months. There was no significant association between DT infiltration and histological subtype or patient characteristics and between DT extent and tumor infiltration. Clustering according to radiomic characteristics was not associated with tumor infiltration (p = 0.89). The radiological dural tail does not reliably outline the extent of tumor cell infiltration in convexity meningiomas. Hence, the extent of dural tail resection should not exclusively be guided by preoperative radiological appearance.

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Dataset Information

The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas.

Background

Methods

Results

Conclusion

Publications

The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas.

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