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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e613-e614
DOI: 10.1055/s-0041-1727109
Skull Base: Operative Videos

Clinoidal Meningioma with Cavernous Sinus Invasion

Adriana Azeredo Coutinho Abrao
1   Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Rio Grande do Sul, Brazil
,
Carlos Eduardo da Silva
1   Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Rio Grande do Sul, Brazil
2   Federal University of Health Sciences of Porto Alegre- UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract

We present a-49-year old female presenting headache and progressive right eye visual loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma on the right side, invading the superior, lateral and medial aspects of the cavernous sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA).

A cranio-orbital approach was performed. The anterior clinoid process was removed extradurally to achieve devascularization of the anterior clinoidal meningioma, followed by the peeling of the middle fossa to decompress V2 and open the superior orbital fissure. We open the dura in a standard fronto-temporal flap to access the lower portion of the skull base allowing retractorless dissection. We complete the removal of the anterior clinoid process and optic strut through an intradural approach. It allows safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent and hard consistency tumor.

Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use of bipolar coagulation when dissecting the cavernous sinus are essential to minimize the risk of cranial nerve injury. We also like to point that cranial nerve deficit caused by surgical manipulation without primary lesion of the nerve can be recovered postoperatively.

The link to the video can be found at: https://youtu.be/ozUCsnUGxyM.


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Keywords

meningioma - anterior clinoid - cavernous sinus - sphenoid wing
Zoom Image
Fig. 1 Axial and coronal magnetic resonance imaging show a large clinoidal meningioma on the right side, invading the superior, lateral and medial portion of the cavernous sinus, the optic canal and circumferential involvement of the internal carotid artery. It extends also to the temporal floor.
Zoom Image
Fig. 2 Intraoperative image demonstrating sharp dissection of the oculomotor triangle to release the third nerve.

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Quality:

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Conflict of Interest

None declared.

Note

The manuscript has not been previously published or submitted elsewhere for review.



Address for correspondence

Carlos Eduardo da Silva, MD, PhD
Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles
Porto Alegre, RS 90160-092
Brazil   

Publication History

Received: 27 March 2020

Accepted: 31 October 2020

Article published online:
17 May 2021

© 2021. The Author(s). 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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Zoom Image
Fig. 1 Axial and coronal magnetic resonance imaging show a large clinoidal meningioma on the right side, invading the superior, lateral and medial portion of the cavernous sinus, the optic canal and circumferential involvement of the internal carotid artery. It extends also to the temporal floor.
Zoom Image
Fig. 2 Intraoperative image demonstrating sharp dissection of the oculomotor triangle to release the third nerve.