Usefulness of Preoperative Simulation in Skull Base Approach: A Case Report

Manish Kolakshyapati; Fusao Ikawa; Masaru Abiko; Takafumi Mitsuhara; Masaaki Takeda; Tejashwi Shrestha; Kaoru Kurisu

doi:10.1055/s-0038-1660843

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2018; 79(S 04): S378-S382
DOI: 10.1055/s-0038-1660843

WFSBS 2016

Georg Thieme Verlag KG Stuttgart · New York

Usefulness of Preoperative Simulation in Skull Base Approach: A Case Report

Authors

Manish Kolakshyapati

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Fusao Ikawa

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Masaru Abiko

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Takafumi Mitsuhara

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Masaaki Takeda

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Tejashwi Shrestha

²Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
Kaoru Kurisu

¹Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

Abstract

Skull base approach is a neurosurgical challenge requiring dexterity of the operating surgeon for good postoperative outcome. In addition to the experience of the operating surgeon, adequate preoperative information of the tumor is necessary to ensure better outcome. In clinoid meningioma, it is sometimes difficult to determine its relationship with the surrounding structure and the feeding artery. Previously, preoperative simulation has been utilized to determine the intracranial course of the compressed nerves in relation to the petroclival meningioma. We report a case of clinoid meningioma where preoperative fusion of three dimensional computed tomography angiography (3D-CTA) and 3T-fast imaging employing steady-state acquisition (FIESTA) images was useful in determining the exact location of the feeding artery to devascularize the tumor and aid in surgery. Preoperative simulation with three-dimensional digital subtraction angiography (3D-DSA) and 3T-FIESTA fusion images can be a useful adjunct tool to supplement surgery and to train neurosurgical trainees.

Keywords

preoperative simulation - skull base - 3D-CTA - FIESTA - clinoid meningioma - feeding artery

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References

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