The far lateral-combined supra- and infratentorial approach: Clinical experience

Baldwin, Hillel Z.; Spetzler, Robert F.; Wascher, Thomas M.; Daspit, C. Phillip

doi:10.1007/bf01417683

Cited by 29 publications

(19 citation statements)

References 10 publications

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“…For hemangioblastomas located in the lateral, anterior, or anteromedial cerebellum, we and others have previously described a variety of approaches that provide optimum visualization and direct access to the tumors in these regions. 4,5,20,30,45 Whichever approach is used, the basic tenets of hemangioblastoma removal (as dictated by their biological features) from the surrounding cerebellar tissues are the same as the technique described here.…”

Section: Surgical Techniquementioning

confidence: 99%

Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease

Jagannathan

Lonser

Smith

et al. 2008

JNS

131

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Object Despite the frequency of cerebellar hemangioblastomas in von Hippel–Lindau (VHL) disease, their optimum contemporary management has not been defined, and is made complex because of the multiple, progressive, and protean nature of the tumors found in patients with this disorder. To examine modern management and outcomes of cerebellar hemangioblastomas in VHL disease, the authors reviewed findings in patients with this disease who underwent resection of cerebellar hemangioblastomas. Methods Consecutive patients with VHL disease who underwent surgery for cerebellar hemangioblastoma(s) at the National Institutes of Health were included. Eighty consecutive patients (44 female and 36 male patients) underwent 126 operations for removal of 164 cerebellar hemangioblastomas (age at surgery 37.8 ± 10.3 years, follow-up duration 96.0 ± 60.3 months). Serial clinical examinations, imaging studies, and operative records were analyzed. Results Symptoms and signs included headache (94 operations; 75%), ataxia (55%), dysmetria (29%), and hydrocephalus (28%). Although the primary objective of surgery was resection of the hemangioblastoma considered responsible for symptoms (136 of the hemangioblastomas [83%]), 28 additional hemangioblastomas (17%) were removed during the same surgeries. Tumors associated with symptoms were larger (diameter 1.8 ± 1.9 cm; volume 2.8 ± 3.4 cm3; p < 0.05) and more likely to be associated with peritumoral edema or peritumoral cysts (100% associated with edema and/or cyst; p < 0.05) than asymptomatic tumors (diameter 1.1 ± 0.9 cm; volume 0.7 ± 0.4 cm3; 18%). More tumors were located in the posterior (74%) compared with the anterior (26%) half of the cerebellum (p < 0.05). Three months after resection, symptom improvement/stabilization had occurred following 124 of the operations (98%). Preoperative hydrocephalus resolved after tumor removal in 33 cases (94%) and did not require cerebrospinal fluid diversion. Long-term imaging follow-up (61.5 ± 15.0 months) revealed no recurrences. Conclusions Symptoms and signs caused by cerebellar hemangioblastomas in VHL disease are associated with edema and peritumoral cyst formation/propagation and are treated safely and effectively with resection. Cerebrospinal fluid diversion is rarely necessary after complete tumor removal in patients with preoperative hydrocephalus. Cerebellar hemangioblastomas are preferentially distributed in the posterior half of the cerebellum, as they are in the brainstem and spinal cord. Tumor recurrence is avoided by meticulous extracapsular resection.

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Section: Surgical Techniquementioning

confidence: 99%

Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease

Jagannathan

Lonser

Smith

et al. 2008

JNS

131

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“…There has been considerable controversy in the neurosurgical literature about the extent of occipital condyle drilling in these cases, with some surgeons supporting partial condyle resection [1,11,18–21], and others advocating against resection altogether [3,20,22]. In our series, partial condylar resection was performed in 9 cases (40.9%), and total resection in only 1 case (4.5%).…”

Section: Discussionmentioning

confidence: 78%

Surgical outcomes of craniocervial junction meningiomas: A series of 22 consecutive patients

Bydon

Martin

et al. 2014

Clinical Neurology and Neurosurgery

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Objective We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes. Methods We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012. Results There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior midline sub-occipital approach (9 cases), the far lateral approach (12 cases) and the lateral retrosigmoid approach (1 case). Gross-total resection was achieved in 45% of patients and subtotal in 55%. The most common post-operative complications were cranial nerve (CN) IX and X deficits. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, spinocranial tumors were detected at a smaller size (p = 0.0724) and treated earlier (p = 0.1398) than craniospinal tumors. They were associated with a higher rate of total resection (p = 0.0007), fewer post-operative CN IX or X deficits (p = 0.0053), and shorter hospitalizations (p = 0.08). Conclusion Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.

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“…Either a far lateral suboccipital craniotomy or a larger craniotomy for a combined supra-/infratentorial approach can be used to gain access to the ventrolateral surface of the lower brainstem. 6 In addition, a subtemporal approach is possible for anteriorly situated lesions that may not be accessible from a ventrolateral angle; 53 however, this approach involves drilling into the petrous temporal bone to expose and then mobilize the petrous carotid artery. Furthermore, a transpeduncular approach to the rostral pons has also been described (Fig.…”

Section: Metencephalic Lesionsmentioning

confidence: 99%

Operative management of brainstem cavernous malformations

Asaad

Walcott²,

Nahed³

et al. 2010

FOC

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Brainstem cavernous malformations (CMs) are complex lesions associated with hemorrhage and neurological deficit. In this review, the authors describe the anatomical nuances relating to the operative techniques for these challenging lesions. The resection of brainstem CMs in properly selected patients has been demonstrated to reduce the risk of rehemorrhage and can be achieved relatively safely in experienced hands.

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The far lateral-combined supra- and infratentorial approach: Clinical experience

Cited by 29 publications

References 10 publications

Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease

Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease

Surgical outcomes of craniocervial junction meningiomas: A series of 22 consecutive patients

Operative management of brainstem cavernous malformations

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