Co-occurrence of Meningioma and Intracranial Aneurysm: A Systematic Review.

A complete understanding of the rare neurosurgical phenomenon of co-occurring meningioma and intracranial aneurysm is important to improve the quality of life and decrease future complications in these patients. In this review, we searched the literature for cases of this rare phenomenon to highlight the most important historical, investigation, and treatment-related factors to improve the accuracy of intraoperative procedural decisions. We searched the PubMed database for case reports on this neurological rare phenomenon to create organized data for our review. Then, we extracted information from these cases and organized it in a table. We identified 19 cases in the literature. In the published studies, there was a predominance of the female sex (73.68%). The mean age of the patients was 54.11 years, with the cases relatively evenly distributed among patients in their 30s, 40s, 50s, 60s, and 70s. Posterior communicating artery aneurysm was the most common among the 19 cases. For meningioma, the frontal lobe and clinoid were the two most affected locations, and the meningothelial histopathology was the most common. Complete tumor resection and aneurysmal clipping were done for the majority of the cases (57.8%) unless there was a complication that deferred simultaneous intervention. Fortunately, most patients (78.95%) recovered completely after surgery. The coexistence of meningioma and intracranial aneurysm has a very high cure rate, postoperative symptom resolution, and a very low recurrence rate. For most cases, neuroimaging investigations are recommended for simultaneous management. This imaging can also highlight other potentially suspicious findings.

Microsurgical Ligation of a Dural Arteriovenous Fistula of the Petrous Apex-A 2-Dimensional Operative Video.

Dural arteriovenous fistulas are rare acquired vascular lesions that represent 15% of the vascular malformations. While endovascular treatment has recently became the first line of treatment, microsurgical ligation may still be indicated in specific cases. We present the case of a 75-year-old patient who presented a progressive tetraparesis culminating in a spastic paraplegia and urinary retention. Cranial and spinal magnetic resonance imaging showed a T2 hypersignal in the cervical spinal cord and lower brainstem associated with flow voids in the subarachnoid space. Brain angiography demonstrated a dural arteriovenous fistula of the right petrous apex fed by the inferior lateral and meningohypophyseal trunks of the right cavernous internal carotid artery and draining in the lateral vein of the pons and the anterior medullary vein. Given the small size and tortuous feeders, endovascular treatment was considered too risky and microsurgical ligation was offered to the patient. The main issue of the microsurgical ligation of the dural arteriovenous fistula is the precise identification of the fistulous point, and therefore a detailed study of the specific vascular anatomy of the cerebellopontine angle is compulsory. Indocyanine green angiography plays a major role in confirming the location of the fistula and its correct occlusion. We discuss the technical nuances of the fistula ligation through a retrosigmoid approach and present Video 1 illustrating these principles. Given the retrospective nature of this report, informed consent was not required.

Posterior Midline Approach for a C2 Schwannoma: 2-Dimensional Operative Video.

C2 schwannomas are rare lesions that may develop in the spinal canal, in the area of the C2 ganglion situated posterior to the C1C2 articulation, in the extraspinal area or in a combination of these 3 sectors.1,2 The surgical removal of these lesions is delicate because of the intimate relationships the schwannomas develop with the V3 segment of the vertebral artery. A variety of lateral, far-lateral, or extreme lateral approaches have been described in order to tackle these lesions. We use a posterior midline approach that takes advantage of the predominantly extradural development of C2 schwannomas. In this technique, the main step is the debulking of the posterior articular sector of the tumor, which is easily accessible through a midline posterior approach and necessitates minimal bone removal. In most cases, removal of the homolateral posterior arch of C1 is sufficient in order to create an adequate access. These maneuvers create the necessary space for dissecting both the intradural and extraspinal sectors of the schwannoma. We present this technique through a case with a minimal intradural component exerting mainly a lateral compression of the spinal cord. The tumor was operated through the midline mini-invasive posterior approach with a favorable result. We demonstrate the surgical technique in video and discuss the nuances.

Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia.

In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.