Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

Yoichi Nonaka; Naokazu Hayashi; Takanori Fukushima

doi:10.1055/s-0041-1727147

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e627-e629
DOI: 10.1055/s-0041-1727147

Skull Base: Operative Videos

Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

Authors

Yoichi Nonaka

¹Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan
Naokazu Hayashi

¹Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan
Takanori Fukushima

²Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States

³Carolina Neuroscience Institute, Raleigh, North Carolina, United States

Abstract

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Keywords

cavernous meningioma - middle fossa approach - transcavernous approach - transzygomatic approach

Fig. 1 Pre- and postoperative MRI. (A) Preoperative postcontrast MRI of the first surgery demonstrates a right-sided large cavernous-petroclival meningioma with severe compression of the brainstem. (B) Postoperative MRI of the first surgery demonstrates a small residual tumor at the right cavernous sinus (yellow arrowhead). (C) Preoperative MRI of the second surgery demonstrates tumor regrowth of the residual cavernous portion with extension to the right posterior fossa. (D) Postoperative MRI of the second surgery demonstrates a residual tumor at the right cavernous sinus (yellow arrowhead) (E), (F) preoperative MRIs of the third surgery demonstrate aggressive tumor regrowth. A large tumor occupies the right middle fossa with multidirectional extension with engulfment of the right cavernous carotid artery. MRI, magnetic resonance imaging.

Fig. 2 Intraoperative still images. (A) Resection of the right middle fossa component of the tumor using an ultrasonic aspirator. (B) The right oculomotor nerve is involved entirely by the tumor. (C) Final view of the gross total resection of the tumor through a transzygomatic-transcavernous and extended middle fossa approach. The cavernous segment of the right carotid artery is denuded with the removal of the intracavernous component of the tumor. The lateral aspect of the brainstem is well exposed.

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Fig. 1 Pre- and postoperative MRI. (A) Preoperative postcontrast MRI of the first surgery demonstrates a right-sided large cavernous-petroclival meningioma with severe compression of the brainstem. (B) Postoperative MRI of the first surgery demonstrates a small residual tumor at the right cavernous sinus (yellow arrowhead). (C) Preoperative MRI of the second surgery demonstrates tumor regrowth of the residual cavernous portion with extension to the right posterior fossa. (D) Postoperative MRI of the second surgery demonstrates a residual tumor at the right cavernous sinus (yellow arrowhead) (E), (F) preoperative MRIs of the third surgery demonstrate aggressive tumor regrowth. A large tumor occupies the right middle fossa with multidirectional extension with engulfment of the right cavernous carotid artery. MRI, magnetic resonance imaging.

Fig. 2 Intraoperative still images. (A) Resection of the right middle fossa component of the tumor using an ultrasonic aspirator. (B) The right oculomotor nerve is involved entirely by the tumor. (C) Final view of the gross total resection of the tumor through a transzygomatic-transcavernous and extended middle fossa approach. The cavernous segment of the right carotid artery is denuded with the removal of the intracavernous component of the tumor. The lateral aspect of the brainstem is well exposed.