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DOI: 10.1055/s-0041-1727147
Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation
Abstract
Objective The aim of this study is to describe surgical management of invasive cavernous sinus meningioma with a combination of skull base approaches.
Design This study is an operative video.
Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. In this video, we describe our experience with the successful treatment of a recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 53-year-old male presented with a 1-year history of progressing right-side complete oculomotor palsy and facial dysesthesia. The patient had previously undergone craniotomy for the right-side petroclival cavernous meningioma ([Fig. 1A] and [B]). Total 8 years after the first surgery, the remaining portion of the cavernous sinus grew up and extended into the posterior fossa ([Fig. 1C]). Then the second surgery was performed to resect only the posterior fossa component ([Fig. 1D]). However, the follow-up magnetic resonance imaging revealed an aggressive tumor regrowth in 2 years. The tumor occupied the right middle fossa with an extension to the posterior fossa and infratemporal fossa ([Fig. 1E] and [F]). We scheduled to perform gross total resection of the tumor through a combined transzygomatic transcavernous and extended middle fossa approach with preparation for vessel reconstruction. Mild adhesion between the tumor and the cavernous carotid artery facilitated complete resection of the intracavernous component of the tumor ([Fig. 2A–C]).
Conclusion A combination of skull base approaches provides multidirectional operative corridors and wide exposure of the skull base lesions.
The link to the video can be found at https://youtu.be/DB_WXFeyBvo.
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Keywords
cavernous meningioma - middle fossa approach - transcavernous approach - transzygomatic approachwww.thieme.com/skullbasevideos
Quality:
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Conflict of Interest
None declared.
Address for correspondence
Publication History
Received: 01 April 2020
Accepted: 03 November 2020
Article published online:
03 May 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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