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DOI: 10.1055/s-0045-1809637
Doing More with Less: Complex Meningiomas Illustrative Case Series
Fazendo mais com menos: Séries de casos ilustrativos de meningiomas complexosFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Abstract
Objective
The present study addresses the challenges of treating complex meningiomas in a low- to middle-income country (L-MIC) with limited access to advanced surgical equipment. The objective is to present innovative low-cost approaches and surgical techniques employed in the absence of a neurosurgical microscope, emphasizing resourcefulness in addressing surgical challenges.
Methods
The senior author conducted surgical interventions on four patients with complex meningiomas in a middle-income country's grade III hospital. Due to resource limitations, surgeries did not utilize a neurosurgical microscope. Instead, the Modified Pure Endoscopic Approach (MAPEnd) technique, intratumoral hydrogen peroxide infiltration, and water dissection were employed for intraoperative vision and magnification support. Thorough preoperative planning was crucial for successful treatment.
Results
The case series includes four illustrative cases ranging from parietal and posterior fossa giant meningiomas to front-parietal and cerebellopontine angle large meningiomas. Despite the limitations, effective tumor resections and favorable patient outcomes were achieved.
Conclusions
In resource-limited settings, where access to advanced neurosurgical equipment is constrained, this study demonstrates the successful treatment of complex meningiomas. The combination of water dissection, intratumoral hydrogen peroxide injection, and the MAPEnd method, along with meticulous preoperative planning, promises favorable surgical outcomes. These techniques contribute to neurosurgical innovation and bridge the gap in providing quality surgical care in L-MICs.
Resumo
Objetivo
O presente estudo aborda os desafios de tratar meningiomas complexos em um país de baixa a média renda (L-MIC) com acesso limitado a equipamentos cirúrgicos avançados. O objetivo é apresentar abordagens inovadoras de baixo custo e técnicas cirúrgicas utilizadas na ausência de um microscópio neurocirúrgico, enfatizando a engenhosidade na resolução de desafios cirúrgicos.
Métodos
O autor sênior realizou intervenções cirúrgicas em quatro pacientes com meningiomas complexos em um hospital de grau III de um país de média renda. Devido às limitações de recursos, as cirurgias não utilizaram um microscópio neurocirúrgico. Em vez disso, foram empregadas a técnica Modified Pure Endoscopic Approach (MAPEnd), infiltração de peróxido de hidrogênio intratumoral e dissecção com água para suporte de visão e ampliação intraoperatória. O planejamento pré-operatório detalhado foi crucial para o tratamento bem-sucedido.
Resultados
A série de casos inclui quatro casos ilustrativos que variam de meningiomas gigantes parietal e fossa posterior a meningiomas grandes frontoparietais e angulares cerebellopontinos. Apesar das limitações, ressecções tumorais eficazes e resultados favoráveis para os pacientes foram alcançados.
Conclusões
Em ambientes com recursos limitados, onde o acesso a equipamentos neurocirúrgicos avançados é restrito, este estudo demonstra o tratamento bem-sucedido de meningiomas complexos. A combinação de dissecção com água, injeção intratumoral de peróxido de hidrogênio e o método MAPEnd, juntamente com um planejamento pré-operatório meticuloso, promete resultados cirúrgicos favoráveis. Essas técnicas contribuem para a inovação neurocirúrgica e preenchem a lacuna na prestação de cuidados cirúrgicos de qualidade em L-MICs.
Palavras-chave
meningioma - neurocirurgia global - LMICs - configurações com recursos limitados - técnicas de baixo custoAuthor's Contribution
• Uriel Tagle-Vega: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Writing-original draft.
• Lucero Vera-Torres: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Writing-original draft.
• Monserrat Medina-Mendez: Conceptualization; Methodology; Visualization; Writing-original draft.
• Joham Choque-Velasquez: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration, Resources; Supervision; Visualization; Validation; Writing-review & editing.
Ethical Aspects
The Local Ethics Committee approved this study.
Publikationsverlauf
Eingereicht: 11. März 2024
Angenommen: 20. März 2025
Artikel online veröffentlicht:
16. Juli 2025
© 2025. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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