Far Lateral Transcondylar Transtubercular Approach for Microsurgical Resection of Foramen Magnum Meningioma: Operative Video and Technical Nuances

James K. Liu; Vincent N. Dodson; Ali T. Meybodi

doi:10.1055/s-0040-1716533

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2021; 82(S 01): S19-S21
DOI: 10.1055/s-0040-1716533

Skull Base: Operative Videos

Far Lateral Transcondylar Transtubercular Approach for Microsurgical Resection of Foramen Magnum Meningioma: Operative Video and Technical Nuances

James K. Liu

¹Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark and Livingston, New Jersey, United States

,

Vincent N. Dodson

¹Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark and Livingston, New Jersey, United States

,

Ali T. Meybodi

¹Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark and Livingston, New Jersey, United States

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Abstract

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Keywords

far lateral approach - transcondylar transtubercular - foramen magnum meningioma - skull base surgery

Fig. 1 (A–C) Preoperative MR imaging. (A) Sagittal gadolinium-enhanced T1-weighted, (B) axial gadolinium-enhanced T1-weighted, and (C) axial T2-weighted showing an extra-axial lesion located in the region of the foramen magnum and ventral to the lower brainstem, in the lower one-third of the clivus. The lesion is dural-based and shows bright enhancement and a prominent dural tail (A) consistent with a foramen magnum meningioma. Flow void signals on the either side of the lesion in the axial imaging (C) show close proximity of the lesion with bilateral vertebral arteries. (D–F) Postoperative MR imaging. (D) sagittal fat-suppressed postgadolinium T1-weighted, (E) axial fat-suppressed post-gadolinium T1-weighted, and (F) axial T2-weighted show total resection of the lesion and satisfactory decompression of the brainstem with intact bilateral vertebral arteries ventral to the medulla. MR, magnetic resonance.

Fig. 2 (A) Intraoperative image showing the initial tumor exposure through a right far lateral transcondylar transtubercular approach with the distorted neurovascular anatomy. The tumor engulfs the right vertebral artery (VA) and compresses the cervicomedullary junction medially. The spinal accessory nerve (XI) is pushed posterolaterally. (B) Intraoperative image showing the surgical field after total resection of the tumor. The caudal cranial nerves are visualized. Note the 2 bundles of the hypoglossal nerve rootlets converging laterally to enter the hypoglossal canal. The ventral attachment of the tumor to the clival dura is coagulated to minimize the risk of recurrence. C1, C1 nerve root; R, right; IX, glossopharyngeal nerve; X, vagus nerve; XII, hypoglossal nerve.

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Fig. 1 (A–C) Preoperative MR imaging. (A) Sagittal gadolinium-enhanced T1-weighted, (B) axial gadolinium-enhanced T1-weighted, and (C) axial T2-weighted showing an extra-axial lesion located in the region of the foramen magnum and ventral to the lower brainstem, in the lower one-third of the clivus. The lesion is dural-based and shows bright enhancement and a prominent dural tail (A) consistent with a foramen magnum meningioma. Flow void signals on the either side of the lesion in the axial imaging (C) show close proximity of the lesion with bilateral vertebral arteries. (D–F) Postoperative MR imaging. (D) sagittal fat-suppressed postgadolinium T1-weighted, (E) axial fat-suppressed post-gadolinium T1-weighted, and (F) axial T2-weighted show total resection of the lesion and satisfactory decompression of the brainstem with intact bilateral vertebral arteries ventral to the medulla. MR, magnetic resonance.

Fig. 2 (A) Intraoperative image showing the initial tumor exposure through a right far lateral transcondylar transtubercular approach with the distorted neurovascular anatomy. The tumor engulfs the right vertebral artery (VA) and compresses the cervicomedullary junction medially. The spinal accessory nerve (XI) is pushed posterolaterally. (B) Intraoperative image showing the surgical field after total resection of the tumor. The caudal cranial nerves are visualized. Note the 2 bundles of the hypoglossal nerve rootlets converging laterally to enter the hypoglossal canal. The ventral attachment of the tumor to the clival dura is coagulated to minimize the risk of recurrence. C1, C1 nerve root; R, right; IX, glossopharyngeal nerve; X, vagus nerve; XII, hypoglossal nerve.