ABSTRACT
Background: The management of foramen magnum meningiomas (FMMs) has been a challenge for skull base neurosurgeons. Since the initial description of a FMM in 1872, various surgical approaches have been described. Posterior and posterolateral FMMs are safely removed through a standard midline suboccipital approach. Nevertheless, we still face controversy regarding the management of anterior or anterolateral lesions. Case Description: A 47-year-old patient presented with progressive headaches, unsteadiness, and tremor. Magnetic resonance imaging showed an FMM that caused significant displacement of the brainstem. Conclusion: This operative video highlights a safe and effective surgical technique for the resection of an anterior foramen magnum meningioma.
ABSTRACT
BACKGROUND: Frontotemporal craniotomies are the most commonly performed neurosurgical approaches. We studied the external bony landmarks on the lateral surface of the skull to identify a "strategic" point where both the anterior and middle cranial fossae are exposed simultaneously during frontotemporal craniotomies through a single burr hole placed over the greater wing of the sphenoid bone (sphenopterional point). OBJECTIVE: This study aimed to anatomically define the sphenopterional point via craniometric measurements taken on the lateral surface of the human skull. METHODS: This study used 100 adult (age >18 years old) human dry crania (200 sides) with the calvaria removed, which were cataloged by gender and age. By using laser transillumination, the sphenopterional point was accurately identified in the temporal fossa. Measurements were taken using easily identifiable bony landmarks. On the basis of these landmarks, the horizontal and vertical distances were established between the sphenopterional point and the frontozygomatic suture. RESULTS: Regardless of gender or the side of the skull, the mean horizontal distance was 21.72 mm (SD, 3.17 mm; range, 14.25 mm-32.58 mm), and the mean vertical distance was 4.76 mm (SD, 1.74 mm; range, 0.00-9.73 mm). Neither the horizontal (right side, P = 0.621; left side, P = 0.341) nor the vertical measurements (right side, P = 0.460; left side, P = 0.609) differed significantly between genders. Therefore males and females present, on average, the same vertical and horizontal measurements on both sides. CONCLUSIONS: According to our measurements, the sphenopterional point is located, on average, 21.72 mm posterior and 4.76 mm superior from the frontozygomatic suture, over the sphenoidal bone component of the pterion region.
Subject(s)
Cephalometry/methods , Craniotomy/methods , Frontal Bone/surgery , Sphenoid Bone/surgery , Temporal Bone/surgery , Adult , Female , Humans , Male , Middle Aged , Transillumination , Young AdultABSTRACT
We describe the unusual case of a 45-year-old male patient harboring an intracranial mass due to cerebral amyloid angiopathy whose clinical and radiological features were those of a low grade glioma. Biopsy revealed cerebral amyloid angiopathy. The clinical, radiological and pathological findings are discussed as we review the available literature.
Subject(s)
Brain Neoplasms/pathology , Cerebral Amyloid Angiopathy/pathology , Glioma/pathology , Brain Neoplasms/surgery , Cerebral Amyloid Angiopathy/surgery , Diagnosis, Differential , Glioma/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative PeriodABSTRACT
Descrevemos o raro caso de um paciente de 45 anos portador de lesão expansiva intracraniana por angiopatia amilóide cerebral com características clínicas e de imagem compatíveis com um glioma de baixo grau. A biópsia revelou angiopatia amilóide cerebral. Os achados clínicos, radiológicos e histopatológicos são discutidos e analisados juntamente à literatura disponível.
Subject(s)
Humans , Male , Middle Aged , Brain Neoplasms/pathology , Cerebral Amyloid Angiopathy/pathology , Glioma/pathology , Brain Neoplasms/surgery , Cerebral Amyloid Angiopathy/surgery , Diagnosis, Differential , Glioma/surgery , Magnetic Resonance Imaging , Postoperative PeriodABSTRACT
Descreve-se a técnica de laminoplastia expansiva cervical e analisam-se os resultados cirúrgicos obtidos em 28 pacientes portadores de mielopatia espondilótica cervical tratados através desse método e com seguimento mínimo de seis meses. Vinte e quatro pacientes (86 por cento) apresentaram melhora clínica, segundo a escala de Nurick, três (10 por cento) permaneceram estáveis e uma paciente faleceu no pós-operatório imediato. Os bons resultados alcançados indicam que essa técnica é simples, eficaz e tem baixo índice de complicações no tratamento da mielopatia espondilótica.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cervical Vertebrae/surgery , Laminectomy/methods , Spondylarthropathies/surgery , Cervical Vertebrae , Follow-Up Studies , Severity of Illness Index , Spondylarthropathies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Twenty-two patients harboring tumors or vascular lesions (AVMs and aneurysms) located at the posterior aspect of the parahipocampal gyrus and the pulvinar of thalamus operated by supratentorial-infraoccipital approach were analysed. Total resection was achieved in all five AVM patients as well as in six out of fifteen tumor patients. This approach was performed in five anatomical specimens (ten approaches); It results, along with the surgical results, allow this approach to be considered a good option for lesions of the pulvinar of thalamus and postero-medial temporal lobe which are evident at the transverse fissure.
Subject(s)
Brain Neoplasms/surgery , Craniotomy/methods , Intracranial Aneurysm/surgery , Intracranial Arteriovenous Malformations/surgery , Adolescent , Adult , Aged , Child, Preschool , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Occipital Lobe/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A modification of the supraorbital approach is proposed in order to improve the access to the medial portions of the anterior and middle fossas (supraselar region). It consists of a midline extension of the frontal craniotomy along with an interhemispheric approach: interhemispheric supraorbital or frontopolar approach. The anatomical basis of this approach were studied in eight cadaveric heads. Its results demonstratete that this approach adequaly access the medial structures of the anterior and medial fossas with minimal brain retraction and wide exposure.
Subject(s)
Cerebral Cortex/anatomy & histology , Craniotomy/methods , Cadaver , Cerebral Cortex/surgery , Frontal Lobe/surgery , HumansABSTRACT
Realizou-se análise de 22 pacientes portadores de tumores e lesões vasculares (malformações arteriovenosas e aneurismas) das regiões posteriores do giro parahipocampal e do pulvinar do tálamo e operados pelo acesso supratentorial-infraoccipital. Em quinze pacientes com tumor, a ressecção foi completa em seis e parcial em nove. Os cinco pacientes com malformação arteriovenosa foram submetidos a exérese total da lesão. Realizou-se também o estudo anatômico deste acesso em cinco segmentos cefálicos (dez lados). Os resultados cirúrgicos e do estudo anatômico sugerem que o acesso supratentorial-infraoccipital representa opção para abordar lesões do pulvinar do tálamo e do lobo temporal posteromedial que afloram na fissura transversa do cérebro.
Subject(s)
Adolescent , Adult , Aged , Child, Preschool , Female , Humans , Male , Middle Aged , Brain Neoplasms/surgery , Craniotomy/methods , Intracranial Aneurysm/surgery , Intracranial Arteriovenous Malformations/surgery , Follow-Up Studies , Magnetic Resonance Imaging , Occipital Lobe/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
É proposta modificação do acesso supraorbital com a finalidade de facilitar a abordagem das regiões mediais das fossas anterior e média (região suprasselar). Ela consiste em estender a craniotomia frontal até a linha média e realizar a abordagem inter-hemisférica: acesso supraorbital inter-hemisférico ou frontopolar. Foram estudadas as bases anatômicas desse acesso em oito cabeças de cadáveres. Os resultados desse estudo demonstram que o acesso supraorbital inter-hemisférico possibilita a abordagem das estruturas mediais da base da fossas anterior e média, com retração cerebral mínima e larga exposição.
Subject(s)
Humans , Cerebral Cortex/anatomy & histology , Craniotomy/methods , Cadaver , Cerebral Cortex/surgery , Frontal Lobe/surgeryABSTRACT
We report the surgically treated case of a 21-year-old caucasian male harboring a cavernous hemangioma of the right internal auditory canal encasing the seventh and eighth cranial nerves complex. Only 18 cases of cavernous hemangiomas of this location have been previously reported. The clinical features, the differential diagnosis and the treatment are discussed.
Subject(s)
Ear Neoplasms/pathology , Ear, Inner/pathology , Hemangioma, Cavernous/pathology , Adult , Cranial Nerves/pathology , Cranial Nerves/surgery , Ear Neoplasms/surgery , Hemangioma, Cavernous/surgery , Humans , Magnetic Resonance Imaging , Male , Neoplasm Invasiveness , Tomography, X-Ray ComputedABSTRACT
Relata-se o caso de homem de 21 anos, leucoderma, portador de angioma cavernoso do meato acústico interno direito envolvendo o complexo VII e VIII nervos cranianos tratado cirurgicamente. Apenas 18 casos de angiomas cavernosos dessa localização foram relatados na literatura. São comentados os aspectos clínicos, o diagnóstico diferencial e o tratamento.
Subject(s)
Adult , Humans , Male , Ear Neoplasms/pathology , Ear, Inner/pathology , Hemangioma, Cavernous/pathology , Cranial Nerves/pathology , Cranial Nerves/surgery , Ear Neoplasms/surgery , Hemangioma, Cavernous/surgery , Magnetic Resonance Imaging , Neoplasm Invasiveness , Tomography, X-Ray ComputedABSTRACT
We describe the surgical technique of expansive cervical laminoplasty and analyse the results in 28 patients treated by this method for cervical spondylotic myelopathy with a minimum follow-up of six months. Twenty-four patients (86%) had clinical improvement according to the Nurick scale while three (10%) had no improvement and one patient died on the first days post-operatively. The good results achieved demonstrate that this technique is simple, effective and has few complications on the treatment of spondylotic myelopathy.
Subject(s)
Cervical Vertebrae/surgery , Laminectomy/methods , Spondylarthropathies/surgery , Aged , Aged, 80 and over , Cervical Vertebrae/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Severity of Illness Index , Spondylarthropathies/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.
Subject(s)
Craniotomy , Decompression, Surgical , Foreign Bodies/surgery , Head Injuries, Penetrating/surgery , Adult , Female , Foreign Bodies/complications , Head Injuries, Penetrating/etiology , Humans , Intracranial Hypertension/prevention & control , Male , Postoperative Period , Tomography, X-Ray ComputedABSTRACT
Relata-se caso de paciente de 22 anos vítima de traumatismo cranioencefálico penetrante por fragmento de fibra de amianto medindo 15 x 12 cm, e seu tratamento bem sucedido por craniectomia descompressiva. Ao contrário da lesão encefálica por projétil de arma de fogo, lesão encefálica penetrante por objeto de baixa energia é incomum. A maioria dos casos relatados na literatura envolve lesões cranio-orbitárias ou autoflagelação em pacientes psiquiátricos. O caso relatado torna-se especial em virtude das grandes dimensões do objeto penetrante, do tratamento por craniectomia descompressiva e do bom resultado funcional alcançado.
Subject(s)
Adult , Humans , Male , Female , Craniotomy , Decompression, Surgical , Head Injuries, Penetrating/surgery , Intracranial Hypertension/prevention & control , Postoperative Period , Tomography, X-Ray ComputedABSTRACT
An analysis of the surgical results of 51 patients harboring 55 paraclinoid aneurysms is performed, along with a throughoutful description of its complex microsurgical technique. The anterior clinoid process was removed by the extradural route after sectioning the dural duplication between the superior orbital fissure and the dura of the temporal lobe, and/or by the intradural approach. All 55 aneurysms was excluded. In two cases the clipping was partial and the internal carotid artery were occluded in three cases. The surgical outcome was good in 42 (82%) patients, moderate incapacity occurred in five (10%) and severe incapacity in one patient (2%). Three patients (6%) died due to brain infarction. Seven patients (13,7%) had additional lesion of the optic nerve, being partial in 4 (7,7%) and total in 3 (6%).
Subject(s)
Carotid Artery, Internal/surgery , Craniotomy , Intracranial Aneurysm/surgery , Microsurgery/methods , Ophthalmic Artery/surgery , Adult , Aged , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/pathology , Male , Middle Aged , Ophthalmic Artery/diagnostic imaging , Ophthalmic Artery/pathology , Subarachnoid Hemorrhage/pathologyABSTRACT
Analisam-se 51 pacientes portadores de 55 aneurismas paraclinóideos (APC) submetidos a tratamento cirúrgico. Em decorrência de tratar-se de procedimento de alta complexidade, descrevemos em pormenor os seus aspectos técnicos. O processo clinóideo anterior foi removido por via extradural após secção da duplicação dural da tenda da fissura orbitária superior e/ou por via intradural. Conseguiu-se exclusão do APC nos 51 pacientes. Em dois casos a clipagem foi parcial e, em três, ocorreu oclusão da ACI. Em 42 (82 por cento) pacientes ocorreu bom resultado; em 5 (10 por cento), incapacidade moderada; em 1 (2 por cento), incapacidade grave e três (6 por cento) faleceram por infarto cerebral. Sete (13,7 por cento) pacientes tiveram lesão adicional do nervo óptico, sendo parcial em 4 (7,7 por cento) e total em 3 (6 por cento).
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Craniotomy , Carotid Artery, Internal/surgery , Intracranial Aneurysm/surgery , Microsurgery/methods , Ophthalmic Artery/surgery , Cerebral Angiography , Carotid Artery, Internal/pathology , Carotid Artery, Internal , Intracranial Aneurysm/pathology , Intracranial Aneurysm , Ophthalmic Artery/pathology , Ophthalmic Artery , Subarachnoid Hemorrhage/pathologyABSTRACT
A topographic study of posterior surface of the petrous pyramid was performed in 20 human cadaveri heads. The distances between the neurovascular structures were measured in the points where they contact the posterior surface of the petrous pyramid. The study also points out the relationship between the bone landmarks and the transverse and the superior petrous sinuses. The result of this study was correlated with the approaches to the cerebellopontine angle.
Subject(s)
Cerebellopontine Angle/anatomy & histology , Cranial Sinuses/anatomy & histology , Petrous Bone/anatomy & histology , Cadaver , HumansABSTRACT
A modification of the conventional suction device for microsurgery is described. It consists of a built-in tube in another tube, being the first connected to the suction device and the second to the irrigation. This suction-irrigator device allows to accomplish the suction and irrigation simultaneously and in a precise way.
Subject(s)
Microsurgery/instrumentation , Therapeutic Irrigation/instrumentation , Equipment Design , Humans , Suction/instrumentationABSTRACT
The knowledge of the craniotopography allows the delimitation of the cranial approaches. In this study the landmarks, defined in relation to the craniometric points and used in the different cranial approaches, were systematized. Twenty two landmarks are described: the first twelve are in relation to the skull base and the remainder are in relation to the skull vertex.
Subject(s)
Skull/anatomy & histology , Skull/surgery , Humans , Skull Base/anatomy & histology , Skull Base/surgeryABSTRACT
Realizou-se o estudo topográfico da face posterior da pirâmide petrosa em 20 segmentos cefálicos de cadáveres humanos. Foram medidas as distâncias entre as estruturas neurovasculares nos pontos em que elas estäo em contato com a face posterior da pirâmide petrosa e realizado o estudo da relaçäo de referências ósseas com os seios transverso e petroso superior. O resultado deste estudo foi correlacionado com as abordagens ao ângulo pontocerebelar