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Madriñán-Navia HJ, Scherschinski L, Benet A, Lawton MT. Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review. Oper Neurosurg (Hagerstown) 2024; 27:137-147. [PMID: 38330415 DOI: 10.1227/ons.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024] Open
Abstract
The dural venous sinus (DVS) is a thin-walled blood channel composed of dura mater that is susceptible to injury during common neurosurgical approaches. DVS injuries are highly underreported, which is reflected by a lack of literature on the topic. Neurosurgeons should be familiar with appropriate techniques to successfully repair an injured DVS and prevent associated complications. This study presents a literature review on the surgical techniques for DVS repair after DVS injury during common neurosurgical approaches. The databases PubMed and Scopus were queried using the terms "cranial sinuses," "superior sagittal sinus," "transverse sinuses," "injury," and "surgery." A total of 117 articles underwent full-text review and were analyzed for surgical approach, craniotomy, lesion location, lesion characteristics, and surgical repair techniques. A literature review was performed, and a comprehensive summary is presented. Data from publications describing DVS lacerations related to pathological conditions (eg, meningioma) were excluded. A total of 9 techniques aiding with bleeding control, hemostasis, and sinus repair and reconstruction were identified, including compression, hemostatic agents, bipolar cautery, dural tenting and tack-up suturing, dural flap, direct suturing, autologous patch, venous bypass, and ligation. The advantages and drawbacks of each technique are described. Multiple options to treat DVS injuries are available to the neurosurgeon. Treatment type is based on anatomic location, complexity of the laceration, cardiovascular status, the presence of air embolism, and the dexterity and experience of the surgeon.
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Affiliation(s)
- Humberto José Madriñán-Navia
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá , Colombia
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
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Quan K, Qin X, Song J, Zhu W. How we do it? The surgical resection of a medial parietal arteriovenous malformation under multimodal imaging technology-guided hybrid operation. Acta Neurochir (Wien) 2023; 165:3787-3791. [PMID: 37845355 DOI: 10.1007/s00701-023-05836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND This report described the surgical resection of a challenging medial parietal lobe arteriovenous malformation (AVM) using the hybrid operation theater with a multimodal imaging-guided technology. METHOD A 29-year-old male was admitted to treat a ruptured medial parietal AVM. The deep and diffusive compartment of the nidus was embolized before resection. Preoperatively and intraoperatively, mixed reality technology with multimodality imaging was utilized for surgical planning and navigation. The nidus was totally resected and confirmed by intraoperative angiography. The patient recovered without sequella. CONCLUSION We hope this report provides new insights into applying multimodal imaging technology-guided hybrid operation for brain AVM.
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Affiliation(s)
- Kai Quan
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China
| | - Xuanfeng Qin
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China
| | - Jianping Song
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China.
- Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China.
- Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China.
| | - Wei Zhu
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China
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Srinivasan VM, Karahalios K, Reddy VP, Scherschinski L, DiDomenico JD, Rahmani R, Catapano JS, Labib MA, Rumalla K, Graffeo CS, Lawton MT. Back to basal: contemporary cerebrovascular cohort study of the supratentorial-infraoccipital approach. J Neurosurg 2023; 138:793-803. [PMID: 35901708 DOI: 10.3171/2022.5.jns22506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this paper was to assess applications of the supratentorial-infraoccipital (STIO) approach for cerebrovascular neurosurgery. METHODS The authors conducted a cohort study of all consecutive cases in which the STIO approach was used during the study period, December 1995 to January 2021, as well as a systematic review of the literature. RESULTS Twenty-five cerebrovascular cases were identified in which the STIO approach was used. Diagnoses included arteriovenous malformation (n = 15), cerebral cavernous malformation (n = 5), arteriovenous fistula (n = 4), and aneurysm (n = 1). The arteriovenous malformations consisted of Spetzler-Martin grade II (n = 3), grade III (n = 8), and grade IV (n = 4) lesions. Lesion locations included the occipital lobe (n = 15), followed by the tentorial dural (n = 4), temporal-occipital (n = 3), temporal (n = 1), thalamic (n = 1), and quadrigeminal cistern (n = 1) regions. Many patients (75%) experienced transient visual deficits attributable to retraction of the occipital lobe, all of which resolved. As of last follow-up (n = 12), modified Rankin Scale scores had improved for 6 patients and were unchanged for 6 patients compared with the preoperative baseline. CONCLUSIONS The STIO approach is a safe and effective skull base approach that provides a specialized access corridor for appropriately selected cerebrovascular lesions.
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Affiliation(s)
- Visish M Srinivasan
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Katherine Karahalios
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Lea Scherschinski
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Joseph D DiDomenico
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Redi Rahmani
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Joshua S Catapano
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Mohamed A Labib
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kavelin Rumalla
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Christopher S Graffeo
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Michael T Lawton
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Gungor A, Gurses ME, Dogan E, Varol E, Gökalp E, Etli MU, Ozoner B. Interhemispheric Transcingulate Sulcus Approach to Deep-Seated Medial Frontal and Parietal Lesions-Fiber Dissection Study With Illustrative Cases. Oper Neurosurg (Hagerstown) 2023; 24:e178-e186. [PMID: 36701601 DOI: 10.1227/ons.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgery for lesions located in the medial frontal and parietal lobes can be quite challenging for neurosurgeons because of morbidities that may arise from damage to critical midline structures or intact neural tissue that need to be crossed to reach the lesion. In our anatomic studies, the cingulate sulcus was observed as an alternative access route for lesions located in medial frontal and parietal lobes. OBJECTIVE To explain the microsurgical anatomy of the medial hemisphere and cingulate sulcus and to demonstrate the interhemispheric transcingulate sulcus approach (ITCSA) with 3 clinical cases. METHODS Five formalin-fixed brain specimens, which were frozen at -18 °C for at least 2 weeks and then thawed under tap water, were gradually dissected from medial to lateral. Diffusion fiber tracking performed using DSI Studio software in data was provided by the Human Connectome Project. Clinical data of 3 patients who underwent ITCSA were reviewed. RESULTS Cingulate sulcus is an effortlessly identifiable continuous sulcus on the medial surface of the brain. Our anatomic dissection study revealed that the lesions located in the deep medial frontal and parietal lobes can be reached through the cingulate sulcus with minor injury only to the cingulum and callosal fibers. Three patients were treated with ITCSA without any neurological morbidity. CONCLUSION Deep-seated lesions in the medial frontal lobe and parietal lobe medial to the corona radiata can be approached by using microsurgical techniques based on anatomic information. ITCSA offers an alternative route to these lesions besides the known lateral transcortical/transsulcal and interhemispheric transcingulate gyrus approaches.
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Affiliation(s)
- Abuzer Gungor
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
| | - Eray Dogan
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Eyup Varol
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Elif Gökalp
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Baris Ozoner
- Department of Neurosurgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
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The Dural Dark-Side Approach for falcine and tentorial meningioma: A surgical series of five patients. Neurochirurgie 2021; 68:29-35. [PMID: 34097920 DOI: 10.1016/j.neuchi.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/23/2021] [Accepted: 05/09/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Falcine or tentorial meningioma can be complex to resect. When large meningiomas are located in eloquent areas, a direct ipsilateral surgical approach may cause brain injury and postoperative neurological deficits. In this series, 5 patients were surgically treated using a contralateral transfalcine or transtentorial approach to minimize brain retraction. This strategy was called the Dural Dark-Side Approach (DDSA). The aim was to analyze the quality of tumor resection and postoperative outcome. MATERIAL AND METHODS In our department, from June 2018 to January 2020, 5 patients underwent microsurgical DDSA for resection of 4 falcine and 1 tentorial meningioma. All tumors were selected on the following two criteria: large>40mm diameter tumor, with surrounding functional cortex. Clinical and radiologic data were retrospectively analyzed. RESULTS AND DISCUSSION Mean follow-up was 20 months. No patients required use of a rigid retractor during surgery. Gross total resection was performed in 3 patients and near-total resection in 2. All patients had favorable neurologic outcome. Postoperative MRI showed no ipsilateral or contralateral brain lesions. CONCLUSION This series suggested that meticulous DDSA allows excellent resection in selected large falcine or tentorial meningioma. The approach offered a safe and effective surgical corridor without injuring the surrounding healthy parenchyma.
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Aftahy AK, Barz M, Wagner A, Liesche-Starnecker F, Negwer C, Meyer B, Gempt J. The interhemispheric fissure-surgical outcome of interhemispheric approaches. Neurosurg Rev 2020; 44:2099-2110. [PMID: 32852637 PMCID: PMC8338818 DOI: 10.1007/s10143-020-01372-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023]
Abstract
Exposure of the anterior skull base is challenging due to strategic structures. The interhemispheric approach (IHA) has turned out to be a feasible technique. We report our experience with IHAs in patients with extraaxial lesions (EAL). We performed a retrospective chart review at a tertiary neurosurgical center between April 2009 and March 2020. We included patients with resection of EAL through IHAs concentrating on surgical technique, complete resection rate, postoperative outcome, and complications. Seventy-four patients resected by an IHA were included: 49 (66.2%) frontal (FIA), nine (12.1%) parietooccipital (PIA), and 16 (21.6%) frontobasal IHAs (FBIAs). Median age at time of surgery was 59 years (range 16–88 years), 47 (63.5%) female and 27 (36.5%) male. Complete resection rate was 83.8% (FIA 89.8%, PIA 55.6%, FBIA 81.3%). Rate of new minor deficits was 17.6%, rate of major deficits 5.4%, total rate 23.0%. 51 (68.9%) WHO°I meningiomas, ten (13.5%) WHO°II meningiomas, two (2.7%) WHO°III meningiomas, nine (12.2%) metastases, one (1.4%) sarcoma, and one (1.4%) local adenocarcinoma were resected. Total complication rate was 27.0%. Rate of major complications requiring intervention was 9.6%. Mean follow-up was 34.2 (± 33.2) months. In patients with lesions of the interhemispheric fissure, overall morbidity and complications are comparatively high. Extensions of IHAs with potential even higher morbidity are not necessary though; we support the use of standardized IHAs. Our findings suggest regular usage of relatively feasible IHAs for a satisfying outcome. Invasive, complicated, or contralateral trajectories were not needed.
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Affiliation(s)
- A Kaywan Aftahy
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Friederike Liesche-Starnecker
- Department of Neuropathology Klinikum rechts der Isar Institute of Pathology School of Medicine, Technical University Munich, Munich, Germany
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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La Rocca G, Sabatino G, Altieri R, Mazzucchi E, Rapisarda A, Ius T, Garbossa D, Cofano F, Olivi A, Della Pepa GM. Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room. Neurosurg Rev 2020; 44:1779-1788. [PMID: 32840722 DOI: 10.1007/s10143-020-01375-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached.
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Affiliation(s)
- G La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - G Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Roberto Altieri
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy.
| | - E Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - A Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - T Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Udine, Italy
| | - D Garbossa
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - F Cofano
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - A Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - G M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Kearns KN, Chen CJ, Tvrdik P, Park MS, Kalani MYS. Outcomes of basal ganglia and thalamic cavernous malformation surgery: A meta-analysis. J Clin Neurosci 2020; 73:209-214. [PMID: 32057609 DOI: 10.1016/j.jocn.2019.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/01/2019] [Indexed: 12/01/2022]
Abstract
Surgical resection of basal ganglia (BG) and thalamic cavernous malformations (CMs) has not yet become standardized in the field of neurosurgery due to the eloquent location of these lesions and the relative paucity of literature on the subject. This review presents a consolidation of the available literature on outcomes and complication rates after surgical resection of these lesions. A systematic literature review was performed via PubMed database for articles published between 1985 and 2019. Studies comprising ≥2 patients receiving surgery for BG or thalamic CMs with available follow-up data were included. Pooled data included patient demographics, CM preoperative characteristics, and surgical outcomes Twenty studies comprising 227 patients were included for analysis. Complete resection was achieved in 94.7% (fixed-effects pooled estimate [FE]: 94.9%[91.0%-97.8%]; random-effects pooled estimate [RE]: 90.0%[79.8%-96.9%]), and hemorrhage of incompletely resected CMs occurred in 50% (FE: 55.9%[25.9%-83.6%]; RE: 55.9%[25.9%-83.6%]) of patients. Early morbidity was observed in 24.0% (FE: 24.9%[17.8%-32.6%]; RE: 24.9%[17.8%-32.6%]). At final follow-up, 67.3% (FE: 67.7%[58.8%-76.0%]; RE: 67.8%[52.2%-81.6%]) and 20.6% (FE: 20.6%[13.6%-28.6%]; RE: 20.9%[9.8%-34.9%]) had improvement and stability of preoperative symptoms, respectively. Mortality rate was 1.3% (FE: 2.3%[0.6%-5.1%]; RE: 2.3%[0.6%-5.1%]). Therefore, high cure rates with low rates of postoperative morbidity can be achieved in BG or thalamic CM surgery. Most patients had improved neurological function at final follow-up. Complete resection should be attempted to reduce rates of repeat hemorrhage.
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Affiliation(s)
- Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States.
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Rinaldo L, Priemer DS, Vortmeyer AO, Cohen-Gadol AA, Brat DJ, Mahajan A, Giannini C, Burns TC. Chordoma of the corpus callosum: case report. J Neurosurg 2019; 131:1380-1386. [PMID: 30497142 DOI: 10.3171/2018.6.jns181028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/11/2018] [Indexed: 11/06/2022]
Abstract
Chordomas are neoplasms that typically arise from midline skeletal structures and rarely originate within the intradural compartment of the CNS. A chordoma arising from the corpus callosum has not been previously described. The authors report the surgical management of a chordoma originating within the splenium of the corpus callosum. To determine the incidence and distribution of intracranial intradural chordoma, a literature search for additional cases was performed. MEDLINE was searched using the MeSH keyword "chordoma," yielding 2010 articles. These articles were screened for cases of primary intradural chordoma rostral to the craniocervical junction, which led to the identification of 46 relevant articles. The authors report the case of a 69-year-old man who initially presented with nonspecific neurological symptoms including spatial disorientation and cognitive decline. These symptoms eventually prompted intracranial imaging, including MRI, which revealed a ring-enhancing, heterogeneous, cystic mass localized within the splenium of the corpus callosum and extending into the bilateral ventricles. The lesion was believed to represent a high-grade glioma and the patient underwent a left interhemispheric approach and subtotal resection. After pathologic evaluation confirmed a diagnosis of an anaplastic chordoma, the patient underwent further resection. A gross-total resection (GTR) was achieved with a transfalcine approach to the contralateral portion of the tumor. Postoperatively, the patient had a partial left homonymous quadrantanopsia, but was otherwise at his neurological baseline. Proton beam radiotherapy was performed to the resection cavity but diffuse intraventricular disease ensued. The results of a literature search suggest that a chordoma arising in the corpus callosum has not been previously described. The present case demonstrates that chordomas can occur in the corpus callosum, and illustrates the utility of a transfalcine approach for GTR of lesions in this location, as well as the need for improved strategies to prevent intraventricular dissemination.
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Affiliation(s)
| | - David S Priemer
- 2Department of Anatomic Pathology and Neuropathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexander O Vortmeyer
- 2Department of Anatomic Pathology and Neuropathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- 3Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana; and
| | - Daniel J Brat
- 4Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Caterina Giannini
- Departments of1Neurosurgery
- 6Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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García-García S, González-Sánchez JJ, Gandhi S, Tabani H, Meybodi AT, Kakaizada S, Lawton MT, Benet A. Contralateral Transfalcine Versus Ipsilateral Anterior Interhemispheric Approach for Midline Arteriovenous Malformations: Surgical and Anatomical Assessment. World Neurosurg 2018; 119:e1041-e1051. [PMID: 30144605 DOI: 10.1016/j.wneu.2018.08.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The contralateral anterior interhemispheric approach (CAIA) is considered to provide surgical advantages to access deep midline lesions: wider working angle, gravity enhanced dissection and retraction, more efficient lighting, and ergonomics. Our team has previously published on the merits of using a contralateral trajectory for medial frontoparietal arteriovenous malformations (AVMs) compared with the conventional anterior interhemispheric approach (IAIA). In this article, we compare the IAIA and CAIA for the resection of medial frontoparietal AVMs using quantitative surgical and anatomical analysis. METHODS Two models were designed mimicking the most common features of midline AVMs. The CAIA and IAIA were performed bilaterally in 10 specimens. Variables to compare technical feasibility (surgical window [SW] and surgical freedom [SF], target exposure, and angle of attack) were independently assessed using stereotactic navigation. The average SW, SF, and angle of attack were compared with the Student t test. Significance threshold was set at 0.05. RESULTS The CITA and IAIA were similar in terms of SW, target exposure, and SF in the superior aspect of the AVM. In the depth of the interhemispheric fissure, the CAIA was significantly superior to IAIA in both AVM models: 77% wider AA for the inferior aspect of the AVM (P < 0.01) and greater SF for the draining vein (54%, P = 0.01), ipsilateral (98%, P = 0.02), and contralateral ACA (117%, P < 0.01). CONCLUSIONS This study suggests technical superiority of the CAIA for the resection of deep midline AVMs. No objective difference was noted in the superficial areas of our models, denoting that IAIA is a safer choice for superficial AVMs. Our results set the foundation for further clinical analysis comparing both approaches.
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Affiliation(s)
- Sergio García-García
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain; Department of Neurosurgery, University of California, San Francisco, California, USA.
| | | | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Halima Tabani
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Sofia Kakaizada
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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