CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S358-S359
DOI: 10.1055/s-0039-1700509
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Resection of a Meningioma at Craniocervical Junction through Far Lateral Approach: Two-Dimensional Operative Video

Yong Yan*
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Hongxiang Wang*
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Tao Xu
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Zhenyu Gong
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Fan Hong
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Xu Zhang
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
,
Juxiang Chen
1  Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China
› Author Affiliations
Disclosure of Funding None.
Further Information

Address for correspondence

Juxiang Chen, MD, PhD
Department of Neurosurgery
Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai
China   

Publication History

22 April 2019

24 August 2019

Publication Date:
23 October 2019 (online)

 

    Abstract

    Tumors located in the craniocervical junction region are significantly challenging for surgical resection. We shared our experience of a meningioma at craniocervical junction resected through far lateral approach in a 68-year-old female. The patient presented with intermittent headache with discomfort in the neck and shoulders for 3 years without any positive signs. Magnetic resonance imaging (MRI) revealed a tumor of 3.6 cm × 3.0 cm × 2.5 cm lying at the ventral side of medulla oblongata, with T1 hypointensity, T2 hyperintensity, and a significant enhancement on T1-contrast image. The far lateral approach on the right side was planned to resect the tumor with a park-bench position. The patient underwent a standard craniotomy using a lazy S-shaped incision. The transposition of vertebral artery was performed carefully therein, followed by removal of part of the arches of atlas and axis. After exposure of the tumor, vertebral artery (VA) and posterior inferior cerebellar artery (PICA) adhesive to the lesion could be seen operatively. Truncating the supplying blood vessels of the tumor was taken as the first step, followed by resecting the tumor mass in a piecemeal manner. While preserving VA, PICA, posterior nerves, medulla oblongata, and cervical cord, gross-total resection was achieved under the careful operation. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as a meningioma (World Health Organization [WHO] grade I). Postoperative MRI scan depicted complete resection of the tumor. The patient remained symptom free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.

    The link to the video can be found at: https://youtu.be/i9H-wS4fF10.


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    Zoom Image
    Fig. 1 Exposure of the suboccipital triangle to distinguish vertebral artery.
    Zoom Image
    Fig. 2 Intraoperative image shows the exact position and adjacent structures of the tumor.

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    Quality:

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    Conflicts of Interest

    None declared.

    * These authors contributed equally to this work.



    Address for correspondence

    Juxiang Chen, MD, PhD
    Department of Neurosurgery
    Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai
    China   


    Zoom Image
    Fig. 1 Exposure of the suboccipital triangle to distinguish vertebral artery.
    Zoom Image
    Fig. 2 Intraoperative image shows the exact position and adjacent structures of the tumor.