Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas: Indications, Surgical Technique and Long Term Outcome.

Ventral lower cervical spinal meningiomas with posterior displacement of the spinal cord are rare and anterior approach has been rarely reported in the literature. The authors present their experience about eight patients operated through anterior microsurgical approach. Exposure of meningiomas was achieved through one or two corpectomies, according to meningioma extension. Tumour removal was performed thanks to the aid of a dedicated ultrasonic aspirator, and intraoperative evoked potentials were employed. Particular care was taken with the materials adopted for reconstruction of the anterior dural plane, to avoid postoperative cerebrospinal fluid leak. Vertebral fusion and stabilization were achieved by tantalum cage or titanium graft in case of one or two corpectomies respectively; anterior titanium plate fixed with screws was applied in all patients. Extent of tumour removal was related to the presence of a conserved arachnoidal plane between the tumour and the spinal cord: total removal was achieved in 2 patients, while gross total removal in the other six ones. Postoperative neurological outcome, which was favourable in all patients, was related mostly to preoperative neurologic status. No recurrence after total removal and no remnant growth after gross total removal occurred during an average follow-up period of 6, 7 years.

Treatment of idiopathic hemifacial spasm with radiosurgery or hypofractionated stereotactic radiotherapy: preliminary results.

INTRODUCTION: Microvascular decompression in the posterior cranial fossa is the first treatment option for hemifacial spasm. For patients not suitable for surgery because of advanced age, poor general conditions or patients who refuse surgery, radiotherapeutic treatment could be an alternative. Only one case of resolution of hemifacial spasm in a patient undergoing radiosurgery for an intracanalicular vestibular schwannoma has been described in the literature. In this article we present three patients affected by idiopathic hemifacial spasm, refractory to medical therapy and botulinum toxin injections, who were treated by radiosurgery in one case and hypofractionated stereotactic radiotherapy in the other two. METHODS: Radiosurgery, with a single dose of 8 Gy, was used in the first patient affected by idiopathic hemifacial spasm and autoimmune polyneuropathy with severe hypoacusia; hypofractionated stereotactic radiotherapy, with 15 Gy in 5 fractions of 3 Gy each, was preferred in the other 2 cases. In all patients, the target consisted of the vestibulocochlear-facial bundle immediately before its entry into the internal acoustic foramen. RESULTS: A marked improvement of symptoms was observed in 2 patients, and almost complete disappearance in the other case, with no complications, particularly, auditory. CONCLUSION: The mean follow-up time of 24 months reported here could be judged too short, and our series too small, but the good results observed so far lead us to underline that, as in trigeminal neuralgia, radiosurgery or hypofractionated stereotactic radiotherapy could represent a therapeutic alternative to microvascular decompression for idiopathic hemifacial spasm for patients not suitable for surgery.

Extended transsphenoidal microsurgical approach for diaphragma sellae and tuberculum meningiomas.

Diaphragma sellae meningiomas represent a difficult challenge for neurosurgeons; they are generally operated on by a transcranial approach. Some authors reported transsphenoidal surgery in selected cases, but without accurately focusing the surgical technique that should be necessary for removing the typical hard fibrous tissue of the meningioma, that is not aspirable, by this approach. We present the surgical technique and the useful instrumentarium for removing a diaphragma sellae meningioma through an extended microsurgical transsphenoidal approach.