We present a case of a 37-year-old female, with progressive left eye proptosis and an extensive ipsilateral en plaque spheno-orbital meningioma, with diffuse involvement of the lateral wall of the cavernous sinus and the orbit.A cranio-orbital zygomatic approach was performed to reach all extension of the lesion. We made an extradural clinoidectomy and an extensive bone removal of the orbit, exposition of the superior and lateral walls of the cavernous sinus, unroofing of the optic canal, superior orbital fissure, foramen rotundum, and foramen ovale. We performed the peeling of the lateral wall of cavernous sinus with total removal and preservation of the cranial nerves anatomy and function.In this video, we illustrate the importance of the first time aggressive removal of such tumors. We also demonstrate the concept that secondary invasion of the cavernous sinus are suitable for removal with cranial nerve preservation.The link to the video can be found at https://youtu.be/GJmkqVa6jSs.
Cavernous malformations (cavernomas) of the brain stem with recurrent hemorrhage may be amenable to microsurgical resection if they are present close to the surface. The risks of surgery need to be balanced with the natural history of the lesion and the accumulation of neurological deficits and risk to life with multiple hemorrhages. In this 3D operative video, we illustrate the technique for the resection of a dorsally located midbrain cavernous malformation.
Informed consent was obtained for this procedure. The cavernoma is accessed with the use of a supracerebellar infratentorial approach. The infratentorial craniotomy and coagulation of the superior vermian veins is shown. A description is provided of the use of hemosiderin staining and the intercollicular relative “safe zone”
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as landmarks for the neurotomy. The technique of cavernoma dissection from the surrounding gliotic plane is shown and described.
In this case, the patient required prolonged rehabilitation but fully recovered without residual deficit 1 yr following surgery.
Neurosurgical centers deal with complex diseases and not rarely patients face a range of impairments or nuisances in the postoperative period. In order to achieve optimal outcomes multidisciplinary teams play an important role during neurorehabilitation. Although the data concerning this issue is limited, some aspects worth to be discussed and reviewed. We present a brief review about the multidisciplinary approach to neurosurgical patients. Individualization of patients' necessities and efficient communication in the team are essential points in this subject.
The ocular bobbing (OB) refers to a distinct pattern of spontaneous vertical eye movements that occurs in various diseases of the posterior fossa pathologies. We describe a case of 42-years-old female submitted to epidermoid tumor removal through a subocciptal approach, presenting an OB during the postoperative period.The clinical aspects of the ocular bobbing are reviewed and discussed. There are other presentations or etiologies for OB, therefore differential diagnosis should always be carefully considered.
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