J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600623
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

How to Approach the Anterior Midline Magnum Foramen Meningiomas? Management of Vertebral and Basilar Arteries as well as the Bulbar Nerves

Paulo H Pires de Aguiar
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Giovanna Matricardi
2   Pontifical catholic University of Sao Paulo, Sao Paulo, Brazil
,
Iracema Estevão
3   Bragança Medical School, São Francisco University, Bragança Paulista - SP, Brazil
,
Fabio Nakasone
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Tatiana A. Vilas Boas
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Daniel A. Gripp
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Marcos Perocco
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Marcos V. Maldaun
1   Santa Paula and Oswaldo Cruz Hospital, Sao Paulo, Brazil
,
Bruno Camporeze
3   Bragança Medical School, São Francisco University, Bragança Paulista - SP, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

The authors presented their series of 21 magnum foramen meningiomas placed medially and anteriorly treated from January 2004 to September 2016, all of them surgically approached by far lateral approach with resection of occipital condyle (retrocondylar), with neurophysiological intraoperative monitoring.

The series showed 15 women and 6 men, with average age of 43.4 years old (minimum: 18 year old and maximum: 61 years old).

The main approach was an far lateral approach with horse shoe shape turned down incision, and sided according to the side of the nondominant vertebral artery, and if the both vertebral arteries were similar in size, we chose the side of nondominant sigmoid venous sinus. We performed the removal of hemi lateral arch of C1 and portion of lateral C1 mass, mobilizing the vertebral artery posteriorly and medially, and a retrosigmoid approach is performed with craniectomy and the bone over the sigmoid sinus is drilled till the complete skeletization of sinus. The bone anteriorly to the sigmoid sinus is drilled too, and we open the duramater in a straight incision from below to above taking care with the sinus and dural arteries sometimes enlarged because tumor feeding. We placed the blade in inferior portion of cerebellar cortex and pull up it gently. The tumor can be resected in piecemeal, also with help of small tip ultrasonic aspirator working among the low cranial nerves, with bipolar pen stimulation all the time. The closure is performed using free abdominal fat and with second sternocleidomastoidea muscle cut and turned to the craniectomy space. The hydrogel seal was used in all cases.

The main operative complications were CSF leak in 6 cases, 28%, surgical bed hemorrhage in one case 4.7%, additional lesion of low cranial nerves in 2 cases 9.5%. The last five cases use used lumbar drainage for 5 days with no CSF leak. One patient developed meningitis after management of CSF leak. The clinical complications were lung thromboembolism in 4 cases 19.0%. Worsening in postoperative spasticity of lower bilateral limbs were observed in two cases. No venous infarction was observed in this series. No mortality was observed in this series.

The grade of resection was Simpson I -10 cases (47.61), Simpson II- 8 cases (38.0%), Simpson III- 3 cases (14.21%).

The three cases of Simpson III were treated by stereotactic fractionated radiotherapy, and in 48 months of average follow-up we observed 4 recurrences in 18 cases, which were treated by radiotherapy devices. We use only in one case preoperative tumor embolization.

The main conclusion is the side of surgical approach is based on the vertebral artery and sigmoid sinus venous dominance.