Cases reported "Meningeal Neoplasms"

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1/14. Far lateral approach with intraoperative ultrasound Doppler identification of the vertebral artery.

    A 69-year-old woman presented with right hemiparesis and magnetic resonance imaging revealed a meningioma at the ventral aspect of the foramen magnum. We used a retromastoid curvilinear incision down the lateral aspect of the neck to expose the semispinalis and other muscles. Guided by ultrasound to avoid damage to the vertebral artery beneath the semispinalis, we incised the semispinalis muscle in a U-shape that hinged at the retromastoid curvilinear incision with its one limb along the border of the foramen magnum and the other limb along the posterior arch of the atlas. The other muscles were divided in line with the curvilinear incision and retracted posteriorly with the bulk of semispinalis to expose the bones, not disturbing the U-shaped piece of semispinalis that covered the vertebral artery. Similarly guided by ultrasound, we performed far lateral suboccipital craniectomy and laminectomy, exposed the dura above and below the dural entry of the vertebral artery, opened the dura cephalad and caudal to the dural entry of the vertebral artery, and excised the tumor. This method provided adequate exposure to the lateral aspect of the cranio-vertebral junction and minimized the risks of dissecting the whole extradural segment of vertebral artery. It requires more cases to determine whether the results of this patient can be generalized.
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2/14. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases.

    OBJECTIVE: The advantages of a posterior "conventional" suboccipital approach with a midline incision over lateral, anterolateral, and anterior approaches to anteriorly placed foramen magnum meningiomas are discussed. methods: From 1991 to March 2000, 17 patients with foramen magnum meningiomas arising from the anterior or anterolateral rim of the foramen magnum underwent operations in the Department of neurosurgery at King Edward Memorial Hospital and Seth G.S. Medical College. All patients were operated on in a semi-sitting position by use of a conventional suboccipital approach with a midline incision and extension of the craniectomy laterally toward the side of the tumor up to the occipital condyle. RESULTS: The patients ranged in age from 17 to 72 years, and the tumors ranged in size from 2.1 to 3.8 cm. The intradural vertebral artery was at least partially encased on one side in eight patients and on both sides in two patients. The brainstem was displaced predominantly posteriorly in each patient. A partial condylar resection was performed in two cases to enhance the exposure. Total tumor resection was achieved in 14 patients, and a subtotal resection of the tumor was performed in the other 3 patients. In one patient, a small part of the tumor was missed inadvertently, and in the other two patients, part of the tumor in relation to the vertebral artery and posterior inferior cerebellar artery was deliberately left behind. After surgery, one patient developed exaggerated lower cranial nerve weakness. There was no significant postoperative complication in the remainder of the patients, and their conditions improved after surgery. The average length of follow-up is 43 months, and there has been no recurrence of the tumor or growth of the residual tumor. CONCLUSION: From our experience, we conclude that a large majority of anterior foramen magnum meningiomas can be excised with a lateral suboccipital approach and meticulous microsurgical techniques.
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3/14. Reverse brain herniation during posterior fossa surgery.

    Posterior fossa tumors are commonly associated with obstructive hydrocephalus. Relieving the raised intracranial pressure by draining the cerebrospinal fluid presents the possibility of reverse herniation of the brain. A 5-year-old male child with a diagnosis of posterior fossa space-occupying lesion and hydrocephalus was scheduled for craniectomy in the prone position. After craniectomy, the surgeons placed an intraventricular shunt catheter to drain out cerebrospinal fluid in an attempt to reduce the tense brain so as to facilitate easy dissection of the tumor. The patient had sudden and severe bradycardia followed by asystole. A diagnosis of reverse coning was made. Immediately, the surgeon injected 10-15 mL normal saline into the ventricles. There was a spontaneous return of the sinus rhythm and the rest of the course of surgery was uneventful. We present this case showing a rare phenomenon and its successful management.
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4/14. Intracranial spread of Merkel cell carcinoma through intact skull.

    We report an unusual case of Merkel cell carcinoma presenting as a frontal scalp mass with apparent invasion into underlying brain parenchyma through grossly intact calvaria. Despite wide local excision, craniectomy, intracranial tumor resection, and postoperative adjuvant irradiation, widespread systemic metastases resistant to chemotherapy developed, and the patient died 9 months after surgery. This case report confirms that Merkel cell carcinoma of the head and neck, already known to be an aggressive tumor, has the capacity for rapid intracranial extension. We propose that in this case, the mechanism of intracranial metastasis was via communicating veins rather than through bone destruction or systemic metastasis. Appropriate preoperative imaging should be carried out to define the extent of this tumor when it is adjacent to the skull. We found contrast-enhanced magnetic resonance imaging to be superior to computed tomography for defining soft tissue extent and marrow space involvement within underlying bone.
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5/14. Primary intraosseous malignant meningioma of the skull: case report.

    Primary intraosseous meningioma of the skull is rare. This report describes a 61-year-old man who was treated by craniectomy 3 times for a repeatedly recurrent primary intraosseous malignant meningioma. Transmission electron microscopy revealed interdigitation of cytoplasmic processes, microfilaments, and distinct desmosomal structures. Immunocytochemical studies of cultured cells showed strong expression of vimentin and weakly positive staining for S-100 protein. Primary intraosseous malignant meningioma should be considered in the differential diagnosis of massive solitary osteolytic lesions of the skull.
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6/14. Cranioplasty with inner table of bone flap. Technical note.

    A new method of cranioplasty is described in which the inner table of the bone flap obtained during craniotomy is used for grafting. The method was used in 10 cases to repair bone defects caused by a growing skull fracture in two, created during removal of an invasive skull tumor in two, during the approach to intraorbital tumors in two, and secondary to craniectomy for additional exposure in four. The method has the advantage that a piece of the inner table for grafting can be obtained from the craniotomy bone flap, without the need for an additional skin incision or taking a graft from another part of the body, and foreign-body reaction is minimal.
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7/14. Straight sinus meningioma.

    Successful removal of a meningioma arising from the straight sinus is described. The tumor was removed via a combined right occipital craniotomy and suboccipital craniectomy. The occluded straight sinus and an unusual vein draining the Galenic system to the superior sagittal sinus were demonstrated angiographically. Various kinds of visual symptoms appeared after the operation, but these gradually cleared.
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8/14. Surgical management of petrous apex meningioma.

    When centered in the petrous apex, meningiomas behave like other neoplasms occuring in that region. The petrous apex can be approached by several routes: posterior craniectomy; middle fossa craniectomy; translabyrinthine, transcochlear, and transethmoidosphenoid approaches. A patient harboring a malignant meningioma in her petrous apex is presented. A middle fossa craniectomy, coupled with posterior displacement of the facial nerve, allowed access to the entire temporal bone from above. The patient received postoperative irradiation.
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ranking = 3
keywords = craniectomy
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9/14. Urgent total removal of a lower clival meningioma.

    A 50-year-old woman was first examined in the emergency room because of inadequate ventilation, rapidly developing respiratory paralysis, and papilledema. Multiple cranial nerve palsies and tetraparesis were present. Carotid angiogram demonstrated bilateral ventricular dilatation. Facilities for computerized tomography and vertebral angiography were not available. Ventriculograms revealed a filling defect of the fourth ventricle without displacement of the midline structures. Immediate exploration of the posterior fossa through a suboccipital craniectomy permitted microsurgical excision of a meningioma of the lower clivus. Spontaneous respirations returned postoperatively and a complete return of neurological functions ensued. The pertinent literature is reviewed.
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10/14. Dural cavernous haemangioma of posterior cranial fossa.

    A rare case of extracerebral dural cavernous angioma sited near the sigmoid sinus is reported. This 60 yr old male patient gave history of episodic ataxia of left sided limbs experienced twice on same day and occasional giddiness. Examination did not reveal any findings. A mass was diagnosed on CT Scan following which angiography was carried out. The features matched with those of a meningioma. Retro-sigmoid craniectomy was performed. Occipital artery was coagulated. Tumor was dissected out. Post-operative course of the patient was uneventful. Histopathology revealed that the mass was a cavernous haemangioma.
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