Abstract
We present a-49-year old female presenting headache and progressive right eye visual
loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma
on the right side, invading the superior, lateral and medial aspects of the cavernous
sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA).
A cranio-orbital approach was performed. The anterior clinoid process was removed
extradurally to achieve devascularization of the anterior clinoidal meningioma, followed
by the peeling of the middle fossa to decompress V2 and open the superior orbital
fissure. We open the dura in a standard fronto-temporal flap to access the lower portion
of the skull base allowing retractorless dissection. We complete the removal of the
anterior clinoid process and optic strut through an intradural approach. It allows
safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent
and hard consistency tumor.
Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use
of bipolar coagulation when dissecting the cavernous sinus are essential to minimize
the risk of cranial nerve injury. We also like to point that cranial nerve deficit
caused by surgical manipulation without primary lesion of the nerve can be recovered
postoperatively.
The link to the video can be found at: https://youtu.be/ozUCsnUGxyM.
Keywords
meningioma - anterior clinoid - cavernous sinus - sphenoid wing
