Endoscope-assisted supracerebellar transtentorial approach to the posterior medial temporal lobe for resection of cavernous malformation

Kalani, M. Yashar S.; Lei, Ting; Martirosyan, Nikolay L.; Oppenlander, Mark E.; Spetzler, Robert F.; Nakaji, Peter

doi:10.3171/2016.1.focusvid.15465

Cited by 30 publications

(5 citation statements)

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“…Earlier anatomic studies have addressed the possibility of endoscope-assisted or purely endoscopic ELSI for accessing the posterior and posterolateral incisural space ( 17 – 19 ). Clinically, endoscope-assisted or purely endoscopic ELSI has been used for removal of supratentorial lesions, such as cavernous malformation in the posteromedial temporal lobe and petroclival meningiomas extending into the middle fossa, with the aid of tentorium incision ( 10 , 20 ). Based on these studies, we attempted to treat central skull base lesions through this novel approach and have succeed in resection of retroinfundibular CP in a recently reported case ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic far-lateral supracerebellar infratentorial approach for resection of posterior clinoid meningioma: Case report and literature review

Bai

Han²,

Sun³

et al. 2023

Front. Oncol.

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IntroductionThe surgery of posterior clinoid meningioma (PCM) remains one of the most formidable challenges for neurosurgeons because of its location at great depth in the cranium and proximity to vital neurovascular structures. Herein, we aim to describe the technique and feasibility of a novel approach, the purely endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA), for resection of this extremely rare entity.Case descriptionA 67-year-old women presented with gradually deteriorating vision in right eye for 6 months. Imaging examinations revealed a right-sided PCM, and the EF-SCITA approach was attempted for tumor resection. Tentorium incision allowed a working corridor toward the PCM in the ambient cistern through the supracerebellar space. During surgery, the infratentorial part of the tumor was found to compress the CN III and posterior cerebral artery medially and encase the CN IV laterally. Following debulking of the infratentorial tumor, the supratentorial part could be exposed and then excised, which had dense adhesions to the ICA and the initial part of the basal vein in front. After total tumor removal, its dural attachment was detected at the right posterior clinoid process and then coagulated under direct vision. The patient on follow-up at 1 month had improvement in visual acuity in right eye, with no restriction of extra-ocular movements.DiscussionEF-SCITA approach combines advantages of the posterolateral approach and endoscopic technique, allowing access to PCMs with seemingly low risks of postoperative morbidity. It would be a safe and effective alternative for resection of lesions in the retrosellar space.

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Section: Discussionmentioning

confidence: 99%

Endoscopic far-lateral supracerebellar infratentorial approach for resection of posterior clinoid meningioma: Case report and literature review

Bai

Han²,

Sun³

et al. 2023

Front. Oncol.

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“…For high-riding lesions, the tentorium can be coagulated and incised to lift the mesial structures and obtain the necessary angle to remove the high component of the lesion. 18 For low-riding lesions, the quadrangular lobule of the cerebellum can be vertically incised to better expose the pontomesencephalic fissure. The key to successful use of the SCIT approach is wide arachnoidal opening of the ambient cistern, allowing the cerebellum to fall away.…”

Section: Posterolateral Surgical Routementioning

confidence: 99%

Approach selection for intrinsic brainstem pathologies

Kalani

Yağmurlu

Martirosyan

et al. 2016

JNS

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“…In the last few years, the rapid development of neuro-endoscopy has brought a great opportunity for the improvement of this approach. Clinically, the purely endoscopic far-lateral SCITA (EF-SCITA) has been used for removal of supratentorial lesions with the aid of tentorium incision, including temporal lobe cavernous malformation (8), petroclival meningiomas extending into the middle fossa (9), and retroinfundibular craniopharyngioma (10). These successful experience motivated us to use the same technique for TN resection.…”

Section: Introductionmentioning

confidence: 99%

Hybrid endoscopic-microscopic surgery for dumbbell-shaped trigeminal schwannoma: case report and literature review

Han

Sun

et al. 2023

Front. Oncol.

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BackgroundThe surgery of dumbbell-shaped trigeminal neurinomas (TN) remains one of the most formidable challenges for neurosurgeons because of its location at great depth in the cranium and proximity to vital neurovascular structures.ObjectiveTo describe the feasibility of a novel technique, synchronous endoscopy and microsurgery via combined far-lateral supracerebellar-infratentorial and subtemporal approach, for resection of this rare entity.MethodsA 53-year-old women presented with progressive left facial numbness for 2 months. Imaging examinations revealed a left-sided dumbbell-shaped TN afflicting the middle and posterior cranial fossa, and a single-stage combined multiportal endoscopic microscopic approach was attempted for tumor resection. Initially, a purely endoscopic far-lateral supracerebellar-infratentorial approach was used to remove the posterior fossa component with the aid of tentorium incision. Subsequently, a microsurgical subtemporal interdural approach was performed for the exposure and separation of tumor within the Meckel cave. Finally, the tumor was pushed into the porus trigeminus under microscopy, thus enabling tumor extraction for the supracerebellar space under endoscopy without anterior petrosectomy.ResultsThe patient evolved favorably without additional neurological deficit after surgery, and postoperative imaging showed a complete resection of the tumor.ConclusionWe describe the first account of multi-corridor hybrid surgery for removal of TN in a dumbbell configuration, which enables one-stage total tumor removal with minimal added morbidity. This hybrid technique may be an effective piece of the surgeon’s armamentarium to improve outcomes of patient with complex skull-base lesions. Further studies with larger case numbers are warranted to confirm the prognostic significance of this technique.

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Endoscope-assisted supracerebellar transtentorial approach to the posterior medial temporal lobe for resection of cavernous malformation

Cited by 30 publications

References 0 publications

Endoscopic far-lateral supracerebellar infratentorial approach for resection of posterior clinoid meningioma: Case report and literature review

Endoscopic far-lateral supracerebellar infratentorial approach for resection of posterior clinoid meningioma: Case report and literature review

Approach selection for intrinsic brainstem pathologies

Hybrid endoscopic-microscopic surgery for dumbbell-shaped trigeminal schwannoma: case report and literature review

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