Cottonoid Sliders: A Simple and Cost-Effective Tool for Retractorless Intracranial Surgery

Exoscopic Retrosigmoid Approach for an Anteromedial Tentorial Meningioma: 2D Operative Video

We present a 2-dimensional operative video (Video 1) of a suboccipital retrosigmoid approach for an anteromedial tentorial meningioma with a specific focus on the use of a surgical exoscope. The patient is a 50-year-old woman who presented to emergency room with a 6-month history of nausea, dizziness, and gait imbalance secondary to a 2.5-cm homogenously enhancing mass originating from the anteromedial tentorium on the right side with associated brainstem compression. Retrosigmoid craniotomy was selected due to the favorable surgical corridor for resection and lower risk of cerebrospinal fluid leak, hearing loss, and seizures compared with other approaches.1-5 The patient consented to the procedure. Video 1 emphasizes the advantages of the exoscope compared with the microscope in optimizing surgeon efficiency, ergonomics, and comfort.6 The unique operating room setup associated with exoscope use is highlighted. The patient underwent uncomplicated gross total resection with a mild trochlear nerve palsy noted postoperatively that was resolved at follow-up.7.

Exoscopic supraorbital approach for a tuberculum sellae meningioma

Tuberculum sellae meningiomas are midline anterior skull base tumors and account for approximately 10-15% of all intracranial meningiomas. Clinical presentation of tuberculum sellae meningiomas is mainly characterized by visual deficits due to optic chiasm compression or optic canal invasion. Treatment options for TSM typically involve surgical resection of the tumor. The relevant microsurgical anatomy of the suprasellar region was discussed. (1,2). Tumor size, anatomical variations can affect the best approach for these tumors, with several approaches been described to access the suprasellar region as pterional, endoscopic endonasal and supraorbital approach that was the choice for this case (3). Besides the surgical corridor, minimally invasive techniques that preserve the surrounding tissue are becoming increasingly popular and are perfectly suited to deep seated lesions. In this article, we present a surgical video of an exoscopic supraorbital approach for resection of a tuberculum sellae meningioma. This is a case of a 42-year-old right-handed female who presented with headaches and progressive vision loss. Patient presented with tumor growth and surgery was indicated. We chose the minimally invasive supraorbital approach and then used the exoscope as magnification tool visualization tool. Gross total resection and decompression of the optic canals was achieved with improvement of visual field deficits.

Retractorless Surgery for Petroclival Meningiomas via the Subtemporal Approach: A Try to Reduce Brain Retraction Injury

Purpose

To present our experience with retractorless surgery for resection of petroclival meningiomas (PCMs) via the subtemporal approach with routine operative instruments.

Methods

Clinical data of patients with PCMs who received surgical treatments via subtemporal approach were retrospectively analyzed. Patient demographics, duration of operation, extent of resection, postoperative brain injury rate, postoperative complication, and surgical outcome were reviewed.

Results

Twenty-nine consecutive patients with retractorless surgery via subtemporal approach performed between November 2018 and November 2021. The gross total resection rate was 82.8% (N = 24). The incidence of postoperative temporal lobe injury was 3.4% (N = 1). All the procedures were completed without fixed retraction or other specialized instruments.

Conclusions

Retractorless surgery via subtemporal approach is a reliable treatment option for PCMs, which can be completed with routine operative instruments.