Far Lateral Approach for Resection of a Foramen Magnum Meningioma: 3-Dimensional Surgical Video.

We present the case of a meningioma of the foramen magnum, in a patient of age 62 yr, who presented at the time of surgery a hemiparesis on the right side at 2 mo of evolution. The patient gave his informed consent for the publication of the case, and approval was obtained from the research department of the hospital where the procedure was performed. The magnetic resonance imaging (MRI) in the mid-sagittal view shows a meningioma of the foramen magnum, with an extension in the posterior fossa and in the upper part of the cervical canal. In the coronal view and in the axial view, we can identify that although it is a meningioma of the anterior part of the foramen magnum, it is observed that the lesion has a displacement towards the right side. In a cadaveric specimen, we show the normal anatomy and the key landmarks for performing the approach. The patient was treated by a far lateral approach with a partial removal of the condyle. We show the craniectomy and the microsurgical technique for the tumor resection step by step. We paid particular attention in the anatomy surrounding the tumor and the tips and tricks for a safe resection. We reached a total resection with a good outcome; the result of the anatomopathological study confirmed the diagnosis of meningothelial meningioma. The dura was closed in a hermetic manner with a synthetic dura patch; then sealant was placed. The bone defect was corrected by placing a mesh in titanium. Then the flap was closed as usual. The patient has a good evolution with 1 yr of follow-up and without lesion in the control MRI.

Microsurgical Resection of Craniocervical Dermoid Cyst by Far Lateral Approach: Case Report and Literature Review

Introduction Intracranial dermoid tumors represent a rare clinical entity that accounts for 0.04 to 0.6% of all intracranial tumors. Their location in the posterior fossa is uncommon. Objectives To report the case of a young woman with a posterior fossa dermoid cyst treated by right far lateral approach. Case Report A 17-year-old woman presenting with swallowing difficulties for 6 weeks was referred for a neurological investigation. Amagnetic resonance imaging (MRI) scan showed a hyperintense T1-weighted large expansive lesion occupying the posterior fossa and compressing the anterior face of the brain stem and cerebellum. The patient underwent surgical treatment by right far lateral approach with decompression of vascular and neural structures. The patient presented an uneventful recovery, and was discharged home on the fourth postoperative day without any additional neurological deficits. The anatomopathological analysis confirmed the diagnosis of dermoid cyst. Conclusion The far lateral approach is a safe and feasible route to appropriately treat large posterior fossa dermoid cysts. Decompression of vascular and neural structures is essential to achieve good symptom control.

Foramen Magnum Meningioma Presenting with Cough Syncope (Case Report and Review of the Literature)

Foramen magnum meningiomas cause different symptoms based on the size and the location of the tumor. They often present with involvement of the long tracts and of the lower cranial nerves.Ataxia and occipitocervical headache are other common symptoms. In the present study, we report a case of foramen magnum meningioma presenting with cough syncope. A mass lesion located anterolateral to the foramenmagnumwas detected in a 38-year-oldmanduring amagnetic resonance imaging (MRI) exam; the lesion extended from the inferior clivus to the level of the C2 vertebra. The neural axis has pushed towards posterior and contralateral side by the mass. We think that syncope occurred due to the encasement of the vertebral arteries by the tumor in addition to the compression of the neural axis. The posterolateral approach without condylar resection provides a safe surgical plane for total excision of these tumors. In our case, the tumor was totally removed and the syncope episodes were resolved.

The far-lateral craniotomy: tips and tricks / A craniotomia extremo-lateral: dicas e truques

This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.

O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.