Keywords
low subfrontal approach - meningioma - anterior clinoid process - extradural dissection
Fig. 1 (A and B) Preoperative magnetic resonance imaging (MRI) with arrows demonstrating the dural-based anterior clinoid and optic canal region lesion. (C) Preoperative computed tomography (CT). (D and E) Postoperative MRI demonstrating lesion resection. (F) Postoperative CT with arrow identifying the anterior clinoidectomy.
Fig. 2 (A) The patient is positioned supine in headholder with head rotated to right and extended to facilitate frontal lobe shift away from the floor of the anterior fossa. Hair-sparing left frontal–temporal incision is approximated by the red line. (B) Postoperative three-dimensional computed tomography reconstruction showing the extent of the craniotomy. (C) Intraoperative microsurgical image showing the low subfrontal dural opening (arrow) permitting visualization of the decompressed left optic nerve after anterior clinoidectomy, optic canal osteotomy, and resection of the left anterior clinoid meningioma. Much of the frontal–temporal dura remains intact and no self-retaining retractors are used thereby avoiding some of the risks of Sylvian fissure dissection and other aspects of wider intradural exposure. (D) Small meningioma tumor specimen largely removed en bloc.
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