Assuntos
Forame Magno , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirurgia , Meningioma/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Forame Magno/cirurgia , Forame Magno/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Imageamento Tridimensional/métodos , Feminino , Neoplasias da Base do Crânio/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
Among the posterolateral corridors to the ventral foramen magnum (FM), the transcondylar fossa (supracondylar transjugular tubercle) approach (TCFA) is indicated for lesions lying anteriorly to the dentate ligament and above the jugular foramen and hypoglossal canal.1-13 It involves the drilling of the condylar fossa, namely the exocranial surface of the jugular tubercle. Despite the anatomic variability of the condyle and posterior condylar emissary vein,14,15 they are important landmarks for the TCFA. The extradural jugular tuberculectomy has no risk of iatrogenic mechanical instability compared with the transcondylar approach. This 2-dimensional operative video (Video 1) aims to show the key technical aspects of the TCFA through the case description of an anterolateral FM meningioma. A 35-year-old male patient with a left anterolateral FM meningioma underwent TCFA in a semisitting position. Drilling of the condylar fossa led to an extradural resection of the jugular tubercle. Posterior condylar emissary veins connecting the sigmoid sinus/jugular bulb with the vertebral venous plexus marked the lateral limit of the approach. Through a suprahypoglossal working corridor, the meningioma was debulked and dissected. Postoperative magnetic resonance imaging confirmed complete resection of the tumor, and the patient was discharged neurologically intact on the third postoperative day. TCFA is a valuable technical option for selected anterolateral FM meningiomas. The perfect knowledge and intraoperative use of specific anatomic landmarks are critical to safely perform the TCFA while maximizing the exposure of the surgical target and decreasing the risk of postoperative mechanical instability of the craniovertebral junction.
Assuntos
Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Humanos , MasculinoRESUMO
Objective To describe our surgical techniques, analyze their safety and their postoperative outcomes for foramen magnum tumors (FMTs). Methods From 1986 to 2014, 34 patients with FMTs underwent surgeries using either the lateral suboccipital approach, standard midline suboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions. Results In the present series, there were 22 (64.7%) female and 12 (35.2%)male patients. The age of the patients ranged from12 to 63 years old.We observed 1 operativemortality (2.9%). A total of 28 patients (82.3%) achieved a score of 4 or 5 in the Glasgow Outcome Scale (GOS). Gross total resection (GTR) was obtained in 22 (64.7%) patients. After the surgery, 9 (26%) patients developed lower cranial nerve dysfunction (LCNd) weakness. The follow-up varied from 1 to 24 years (mean: 13.2 years). Conclusion Themajority of tumors located in the FMcan be safely and efficiently removed usingeither thelateral suboccipital approach, standardmiddlelinesuboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions.
Assuntos
Procedimentos Neurocirúrgicos/métodos , Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Prontuários Médicos , Estudos Retrospectivos , Resultado do Tratamento , Craniotomia/métodos , Forame Magno/anormalidades , Forame Magno/fisiopatologia , Meningioma/patologiaRESUMO
We present the case of a meningioma of the foramen magnum, in a patient of age 62 yr, who presented at the time of surgery a hemiparesis on the right side at 2 mo of evolution. The patient gave his informed consent for the publication of the case, and approval was obtained from the research department of the hospital where the procedure was performed. The magnetic resonance imaging (MRI) in the mid-sagittal view shows a meningioma of the foramen magnum, with an extension in the posterior fossa and in the upper part of the cervical canal. In the coronal view and in the axial view, we can identify that although it is a meningioma of the anterior part of the foramen magnum, it is observed that the lesion has a displacement towards the right side. In a cadaveric specimen, we show the normal anatomy and the key landmarks for performing the approach. The patient was treated by a far lateral approach with a partial removal of the condyle. We show the craniectomy and the microsurgical technique for the tumor resection step by step. We paid particular attention in the anatomy surrounding the tumor and the tips and tricks for a safe resection. We reached a total resection with a good outcome; the result of the anatomopathological study confirmed the diagnosis of meningothelial meningioma. The dura was closed in a hermetic manner with a synthetic dura patch; then sealant was placed. The bone defect was corrected by placing a mesh in titanium. Then the flap was closed as usual. The patient has a good evolution with 1 yr of follow-up and without lesion in the control MRI.
Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias da Base do Crânio , Dura-Máter , Forame Magno/diagnóstico por imagem , Forame Magno/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgiaRESUMO
INTRODUCTION: The clivus is a bony structure formed by the fusion of the basioccipital and basispheniod bone at the sphenooccipital synchondrosis. This downward sloping structure from the dorsum sellae to the foramen magnum is derived from mesoderm and ectoderm properties. METHODS: This comprehensive review of the clivus will discuss its basic anatomy, embryology, pathological findings, and surgical implications. The clivus is an endochondral bone, formed under two processes; first, a cartilaginous base is developed, and it is secondly reabsorbed and replaced with bone. Knowledge of its embryological structure and growth of development will clarify the pathogenesis of anatomical variants and pathological findings of the clivus. CONCLUSIONS: Understanding the anatomy including proximity to anatomical structures, adjacent neurovasculature properties, and anatomical variants will aid neurosurgeons in their surgical management when treating pathological findings around the clivus.
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Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/patologia , Procedimentos Neurocirúrgicos/métodos , Fossa Craniana Posterior/embriologia , Fossa Craniana Posterior/cirurgia , Forame Magno/anatomia & histologia , Forame Magno/embriologia , Forame Magno/patologia , Forame Magno/cirurgia , Humanos , Osso Occipital/anatomia & histologia , Osso Occipital/embriologia , Osso Occipital/patologia , Osso Occipital/cirurgiaRESUMO
OBJECTIVE: Success rates of surgical interventions for lumbar disorders vary significantly depending on multiple factors and, among them, the duration of symptoms. It is not clear whether there is a "cutoff" time when decompression and fusion surgery becomes less effective in the conditions with chronic nerve root compression symptomatology. The main objective of this study was to analyze whether duration of symptoms has any effect on clinical outcomes and primarily resolution of radicular pain symptoms due to degenerative disk disease and stenosis with spondylolisthesis in patients undergoing transforaminal lumbar interbody fusion (TLIF). METHODS: The prospective observational study was performed. Eighty-four patients with radicular symptoms due to degenerative disk disease and stenosis with spondylolisthesis with no previous fusion surgeries and undergoing 1- to 3-level TLIF surgery were enrolled. Fifteen patients (18%) were lost to follow-up and were excluded from this analysis leaving a total of 69 patients. Standardized questionnaires were used to analyze clinical outcomes and were administered preoperatively within 3 months of scheduled surgery, and postoperatively at 3, 6, 12, and 24 months. To emphasize the change in clinical outcome scores, the relevant scores were calculated as the ratio of minimal clinically important difference values and change scores. The change scores were calculated by subtracting the postoperative scores from the baseline scores. Multiple regression analyses were conducted to examine the relationship of the duration of symptoms and relevant minimal clinically important difference ratio values while controlling for independent variables. Further, a comparison between 2 groups of patients was performed to analyze the changes of clinical outcomes for the patients who underwent fusion within <24 months versus ≥24 months. RESULTS: It was determined that the duration of symptoms was a significant predictor of better leg pain resolution (P=0.018), but not back pain resolution (P=0.27), or improvement in ODI (P=0.10) and SF-36 PCS scores (P=0.19). The patients with shorter duration of symptoms had significantly better radicular symptom resolution (P=0.032) compared with patients who waited at least 24 months or longer to undergo fusion. CONCLUSIONS: A shorter duration of symptoms was found to be a statistically significant predictor for better resolution of radicular symptoms in patients undergoing TLIF for painful degenerative disk disease and stenosis with spondylolisthesis.
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Forame Magno/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Fusão Vertebral , Adulto , Idoso , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores de TempoRESUMO
OBJECTIVE: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas. METHOD: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC). RESULTS: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each. CONCLUSIONS: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits.
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Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adulto , Idoso , Brasil , Feminino , Seguimentos , Forame Magno/patologia , Hospitais Públicos , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Objective: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas. Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC). Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each. Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits. .
Objetivo: Analisar as evoluções clínicas de 13 pacientes com meningiomas do forame magno (FM). Método: Foram estudados 13 pacientes com meningiomas do FM (11 Feminino / 2 Masculino) operados por abordagem suboccipital lateral. As evoluções clínicas foram analisadas usando curvas de sobrevida (SC) e de sobrevida livre de doença (RFSC). Resultados: Os 13 tumores eram Grau I da Organização Mundial de Saúde. Ressecções total, subtotal and parcial foram obtidas em 69,2%, 23,1 e 7,7%, respectivamente. A SC foi melhor para homens e a RFSC foi melhor para mulheres. Localização/ extensão da ressecção/envolvimento da artéria vertebral/nervos cranianos baixos não influenciaram a SC/RFSC. A taxa de recorrência foi 7,7%. A mortalidade operatória foi zero. As principais complicações foram déficits de nervos cranianos baixos transitórios (38,5%) e permanentes (7,7%); fístula de líquido cefalorraquidiano (30,8%) e dificuldades respiratórias transitórias e permanentes em 7,7% cada. Conclusões: Meningiomas do FM podem ser adequadamente tratados em hospitais públicos em países em desenvolvimento se houver uma equipe multidisciplinar para cuidar de déficits de nervos cranianos baixos pós-operatórios. .
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Brasil , Seguimentos , Forame Magno/patologia , Hospitais Públicos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/patologia , Meningioma/patologia , Gradação de Tumores , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinical-radiological findings, the surgical approach and the outcomes after mid-term follow up. Over a 5-year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. The medical records were reviewed in order to analyze the clinical-radiological aspects, as well as the surgical approach and the outcomes. Based on the preoperative magnetic resonance imaging exams, the tumors were classified as anterior or anterolateral in the axial slices and clivospinal or spinoclival in the sagittal slices. The lateral approach was used in all cases. However, the extent of bone removal and the management of the vertebral artery were tailored to each patient. Fourteen patients were females, and one was male, ranging in age from 42 to 74 years (mean 55,9 years). The occipital condyle was partially removed in eight patients, and in seven patients, removal was not necessary. Total removal of the tumor was achieved in 12 patients, subtotal in two, and partial resection in one patient. Postoperative complications occurred in two patients. Follow-up ranged from 6 to 56 months (mean 23.6 months).There was no surgical mortality in this series. The extent of the surgical approach to foramen magnum meningiomas must be based on the main point of dural attachment and tailored individually case-by-case. The differentiation between the clivospinal and spinoclival types, as well as anterior and anterolateral types, is crucial for the neurosurgical planning of foramen magnum meningiomas.
Assuntos
Forame Magno/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Idoso , Anestesia Geral , Fossa Craniana Posterior/cirurgia , Craniotomia , Feminino , Seguimentos , Forame Magno/patologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Meningioma/patologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introdução: O Forame e o nervo Infraorbital são estruturas bilaterais que se situam abaixo do rebordo inferior da órbita (1,2,5,9,10,11,12) e são parâmetros cirúrgicos importantes para o acesso externo ao seio maxilar (CaldwellLuc), representando seu limite superior (4,13). Objetivo: Estabelecer uma distância média segura, entre o ápice do alvéolo do primeiro dente pré-molar até o Forame e nervo Infraorbital durante a cirurgia pela via CaldwellLuc. Método: Dissecamos 32 cabeças formolizadas de cadáveres adultos brasileiros, sem distinção de idade, sexo ou cor, no período de fevereiro a julho de 2004. A abordagem cirúrgica foi pela via de CaldwellLuc até a exposição completa do Forame e do nervo Infraorbital onde traçamos uma linha imaginária do ápice do alvéolo do primeiro dente pré-molar até o forame e medimos com paquímetro. Resultados: A média geral da distância entre as estruturas citadas foi de 3,34cm, com desvio padrão de 0,52cm. A maior distância encontrada foi de 4,50 cm e a menor foi de 2,50cm, bilateralmente. Conclusão: Conhecendo se a medida segura para o acesso cirúrgico desta região teremos menos danos à inervação causando menos sintomas subjetivos intensos e pouco duradouros no pós-operatório.
Introduction: The infraorbital nerve and foramen are bilateral structures, located below the lower edge of orbit (1,2,5,9,10,11,12), and are important surgical parameters for external access to the maxillary sinus (CaldwellLuc), representing its upper limit (4, 13). Objective: Establishing a safe average distance between the first premolar tooth alveolus top up to the foramen and infraorbital nerve, during the CaldwellLuc surgery. Method: We have analyzed 32 formolized heads of Brazilian adult corpses, without distinction of age, sex and race, within the period of February through July 2004. Surgical approach was made by CaldwellLuc passage, up to the complete exposure of infraorbital nerve and foramen where we delineated an imaginary line from the top of the first premolar tooth alveolus up to the foramen, and measured by using a pachymeter. Results: The general average distance between the structures mentioned was of 3.34cm with standard deviation of 0.52cm. The greater distance found was of 4,5 cm and the minor was of 2.5 cm bilaterally. Conclusion: When we know this region safe distance surgical access, we find less damage to the innervation that causes less intense subjective and less persistent symptoms in the post-operative period.