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Petroclival meningioma embolization

Kensuke Suzuki, Masaya Nagaishi, Yoshiyuki Matsumoto, Yoshiko Fujii, Yuki Inoue, Yoshiki Sugiura, Koji Hirata, Ryotaro Suzuki, Yosuke Kawamura, Ryuta Nakae, Yoshihiro Tanaka, Akio Hyodo
The results of preoperative embolization for skull base meningiomas were retrospectively evaluated to confirm the efficacy of this procedure. Skull base meningiomas that were treated with preoperative embolization were evaluated in 20 patients. The occluded arteries, embolic materials, treatment time, excision rate, neurologic manifestations, and complications were analyzed. The embolic material was 80% liquid, 30% coils, and 15% particles. The surgery was normally completed within 3 to 5 hours. Blood loss was normally approximately 250 mL, excluding four patients having the following conditions: malignant meningioma, a large tumor located on the medial side of the sphenoidal ridge, the petroclival tumor, and infiltrated tumor into the sigmoid sinus...
August 2017: Journal of Neurological Surgery. Part B, Skull Base
Stéphanie Lenck, Kentaro Watanabe, Jean-Pierre Saint-Maurice, Moujahed Labidi, Marc-Antoine Labeyrie, Sébastien Froelich, Emmanuel Houdart
Background and importance The marginal tentorial artery runs over the free edge of the tentorium. Different origins have been described, always involving branches of the carotid artery. We report the superior cerebellar artery as an unknown origin of this artery. We developed our strategy in a case of a tentorial meningioma mainly supplied by this artery. Clinical presentation A 53-year-old man was admitted in our institution for the surgical treatment of a large tentorial and petroclival meningioma. A 2D conventional angiogram was insufficient to detect the tumoral blush...
August 2017: Interventional Neuroradiology
Rami Almefty, Ian F Dunn, Svetlana Pravdenkova, Mohammad Abolfotoh, Ossama Al-Mefty
OBJECT: The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. METHODS: The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O...
January 2014: Journal of Neurosurgery
Yasuhiro Yonekawa
Suboccipital craniotomy (SOC) can be classified into three types: midline, paramedian and lateral according to the site of linear incision. They are subdivided horizontally into cranial, intermediate and caudal, while the latter of the lateral SOC should be included into the paramedian caudal one (Fig. 1, 19). Sitting position for the craniotomy has several advantages over other positionings in spite of several known drawbacks especially air embolism: cleanliness of the operative field, good anatomical orientation, wider operative spaces obtained by gravitational downward displacement of the cerebellar hemisphere above all...
August 2011: No Shinkei Geka. Neurological Surgery
George A Alexiou, Pinelopi Gogou, Sofia Markoula, Athanasios P Kyritsis
The primary treatment of meningiomas is surgery which can be curative if the tumor is completely removed. For parasagittal, lateral sphenoid wing and olfactory groove meningiomas, gross-total resection should be the goal. Tuberculum and diaphragma sella meningiomas can be resected through the subfrontal or the pterional approaches. In meningiomas of the sphenoid wing with osseous involvement or involvement of the cavernous sinus subtotal resection can be achieved via several surgical approaches. Similarly, subtotal resection rather than gross-total resection of meningiomas of the petroclival, parasellar, and posterior fossa regions can preserve neurological function...
April 2010: Clinical Neurology and Neurosurgery
Yutaka Kai, Jun-Ichiro Hamada, Motohiro Morioka, Shigetoshi Yano, Hideo Nakamura, Keishi Makino, Takamasa Mizuno, Hideo Takeshima, Jun-Ichi Kuratsu
INTRODUCTION: Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. METHODS: Prior to preoperative superselective embolization with 200 mum diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal...
May 2007: Neuroradiology
Noboru Kusaka, Takashi Tamiya, Kenji Sugiu, Koji Tokunaga, Mitsuhisa Nishiguchi, Kazuhiro Takayama, Yasuhiko Maeda, Kotaro Ogihara, Minoru Nakagawa, Tsukasa Nishiura
A 57-year-old female presented with a left petroclival meningioma fed by the meningohypophyseal trunk of the internal carotid artery (ICA). The enlarged tentorial marginal artery and inferior hypophyseal artery were successfully embolized with the TruFill DCS Detachable Coil System through a 0.019-inch inner diameter microcatheter. Superselective catheterization into the dorsal meningeal artery could not be achieved with the same microcatheter, because the catheter tip was too large to pass into the vessel...
January 2007: Neurologia Medico-chirurgica
M Hirohata, T Abe, H Morimitsu, N Fujimura, M Shigemori, A M Norbash
We assessed the clinical value of preoperative embolisation of the dural branches of the internal carotid artery (ICA) in cases of petroclival meningioma was evaluated. We carried out preoperative selective embolisation on seven consecutive patients with large petroclival meningiomas, using nonbraided 2 F steam-shaped microcatheters and shapeable hydrophilic microguide-wires to enter the dural branches of the ICA. The embolisations were performed using digital subtraction fluoroscopy with 150-250 microm polyvinyl alcohol particles...
September 2003: Neuroradiology
A Katsumata, N Kusaka, K Sugiu, H Nakashima, I Date, T Ohmoto
Currently, embolization of small branches of the internal carotid artery (ICA) can be embolized through superselective microcatheterization, followed by the injection of liquid or particulate embolic materials. Often, however, a microcatheter cannot be placed in a stable enough position to allow an endovascular surgeon to perform a safe embolization, and the reflux of embolic agents into the main trunk of the ICA is a major concern. Meticulous technique and a detailed knowledge of the vascular anatomy of the cavernous sinus region are necessary to maximize devascularization of the lesion and to minimize the risk of complications...
June 2001: No Shinkei Geka. Neurological Surgery
G Neil-Dwyer, D A Lang, A Davis
BACKGROUND: The aim of this study was to determine outcome, including quality of life, after surgery for petroclival meningioma using a standard skull base approach and to carry out an evidence based appraisal of the relevant literature. METHOD: Pre- and post-operative data including adverse events were prospectively recorded in 19 patients (15 females, age range 29-63) undergoing a transpetrous approach for a petroclival meningioma. Patients were assessed using the GOS and SF-36 post operatively...
2000: Acta Neurochirurgica
A Morita, L N Sekhar
Protection of the vein of Labbé is a significant concern during surgery that involves retraction of the temporal lobe. A cranial base surgical approach, especially one via the presigmoid-petrosal route, carries considerable risk to this venous complex. A case is presented in which a large dominant vein of Labbé was injured during resection of a petroclival meningioma. This vein drained all the sylvian venous circulation as well as the lateral temporal surface; no connection to another venous system was noted...
October 1998: Journal of Neurosurgery
C Lin, Y Node, A Teramoto
Surgery for posterior skull base tumors may be associated with high morbidity and mortality because of the complex anatomy, irregular bony topography, and vital neurovascular structures in this region. We experienced three benign posterior skull base tumors. These were petroclival and foramen magnum meningiomas and a jugular formen neurinoma. Three dimensional computed tomography (3 D-CT) in addition to the conventional CT, magnetic resonance imaging (MRI), and cerebral angiography were performed preoperatively...
August 1998: Nihon Ika Daigaku Zasshi
M Tymianski, R A Willinsky, C H Tator, D Mikulis, K G TerBrugge, L Markson
A highly vascular petroclival meningioma supplied by tentorial branches of the internal carotid artery was embolized by temporary balloon occlusion of the parent vessel distal to the tumor, followed by obliteration of the tumor vascularity with polyvinyl alcohol particles. Subsequently, in vivo proton spectroscopy showed necrosis of a large portion of the tumor and helped determine the timing of surgery. Both innovative techniques considerably facilitated the subsequent radical excision of the tumor with no neurological morbidity...
November 1994: Neurosurgery
O Al-Mefty, J L Fox, R R Smith
Thirteen patients harboring large petroclival meningiomas are reported. The evolution of the petrosal approach is discussed, and modifications for improvement in surgical technique are described. There was no mortality in this series, and total removal was achieved in all but two patients. Morbidity included cranial nerve deficit, pulmonary embolism, and hemiparesis.
March 1988: Neurosurgery
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