Abordaje órbito-cigomático asociado a peeling de fosa media en la resolución quirúrgica de un caso de meningioma paraclinoideo / Orbito-zygomatic approach associated with peeling of the middle fossa in the surgical resolution of a case of paraclinoid meningioma

OBJETIVO: demostrar la utilidad del abordaje órbito-cigomático (O-C) asociado a peeling de fosa media para la resolución quirúrgica de un caso de meningioma paraclinoideo (MP). MATERIAL Y MÉTODO: se presenta el caso de un paciente de sexo femenino de 53 años de edad, que consulta por disminución de la agudeza visual del ojo derecho como síntoma principal. Se identificó además, durante el examen neurológico, hipoestesia en el territorio de las ramas V1 y V2 del V par craneal. Se realizó IRM de cerebro sin y con contraste, que muestra una lesión compatible con MP derecho con extensión predominantemente para y supraselar. La angiografía digital objetiva aferencias predominantes desde la arteria meníngea media (AMM). Se decidió intervenir quirúrgicamente mediante un abordaje O-C en 2 piezas asociado a peeling de fosa media. RESULTADOS: se logró la exéresis total (Simpson 2) del tumor. La paciente presentó mejoría de la sintomatología visual, manteniendo los síntomas trigeminales. La tomografía de cerebro de control mostró la exéresis completa del MP. CONCLUSIÓN: el abordaje órbito-cigomático en 2 piezas permitió una mayor exposición del MP, necesaria para lograr la exéresis total del tumor y en especial de la extensión superior de la lesión. La disección, coagulación y sección de la AMM mediante el peeling de fosa media, disminuye drásticamente el sangrado intraoperatorio. Esta técnica brinda además la posibilidad de disecar de forma extradural, el plano que separa el tumor de las ramas del nervio trigémino. La combinación de estas técnicas permitió la resolución quirúrgica del caso con excelente resultado, por lo que recomendamos su utilización en casos similares al que se presenta

OBJECTIVE: to demonstrate the usefulness of the fronto-orbital-zygomatic approach with associated peeling of the middle fossa for the surgical resolution of a case of paraclinoid meningioma. MATERIAL AND METHODS: we report the case of a 53-year-old woman, whose main symptom was a decreased visual acuity of the right eye. During neurological examination we also identified hypoesthesia in the territory of V1 and V2 branches of of the Vth cranial nerve. Brain MRI with and without contrast was performed showing injury compatible with paraclionid meningioma with suprasellar extension. Digital angiography showed predominant afferent vessels from the middle meningeal artery. Therefore we decided to perform a surgical procedure through an orbital-zygomatic approach in 2 pieces associated to a middle fossa peeling and subsequently a transsylvian approach. RESULTS: the patient experienced visual improvement after the procedure, but no changes in trigeminal symptoms were found. Control brain scan showed complete excision without evidence of any remnant. CONCLUSION: the orbital-zygomatic approach in 2 pieces allows the surgeon to achieve greater exposure, required to achieve a better view of the superior extension of this brain injury. Dissection, coagulation and section of the middle meningeal artery through a middle fossa peeling, drastically decreased intraoperative bleeding. For reduced shrinkage during the extradural step, it is necessary to install a continuous lumbar drainage

Zygomatic Approach for High Placed Basilar tip Aneurysm: Case Report

The surgical approach to high placed basilar tip aneurysm presents a special technical problem. The author experienced the case of a 70-year-old female who developed subarachnoid hemorrhage due to rupture of superoposteriolry projecting and high placed basilar tip aneurysm. For the purpose of minimal brain retraction and excellent exposure, the author used a technique which was a combination of the detachment of the zygomatic arch and pterional approach. This aneurysm was clipped successfully and easily with the zygomatic approach, but under the anesthesia there was a severe subcutaneous emphysema and pneumothorax which was produced through a tracheostomy site.

Zygomatic Temporopolar Approach to High Placed P1 Aneurysm

The authors describe the case of a 57-year-old female who developed subrachnoid hemorrhage secondary to rupture of posteriorly projecting, high placed aneurysm of the proximal posterior cerebral artry. This aneurysm was treated easily and successfully with the zygomatic temporopolar approach which was modification of the temporopolar approach proposed by Sano by detaching the zygomatic arch to get a wide and flexible operating field.