Partial Transcondylar Approach for Ventral Foramen Magnum Neurenteric Cyst: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E81-E81
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Hitoshi Izawa ◽  
Yujiro Tanaka

Abstract The anterior foramen magnum area, ventral to the brainstem is one of the most difficult regions to access surgically, and the extent of osseous drilling through the far-lateral or transcondylar approach should be planned in each case based on the tumor extension.1,2 This video, reproduced after informed consent of the patient, demonstrates a case of a ventral foramen magnum neurenteric cyst surgically treated using the partial transcondylar approach. A 27-yr-old woman presented with gait disturbance, oscillopsia, and transient arm numbness. Neuroimaging revealed a ventral foramen magnum cystic tumor involving the basilar and bilateral vertebral arteries. The tumor extended inferiorly from the middle clivus to the C1 level, and occupied the whole premedullary cistern compressing the bilateral lower cranial nerves. The left partial transcondylar approach was performed with drilling the condylar fossa, superior part of the occipital condyle, C1 posterior arch, and posterior part of the jugular process to achieve the sufficient surgical view from the inferolateral side. The drilling of the occipital condyle was minimized so that the articular facet of the occipital condyle was preserved. The tumor on the bilateral side was completely removed as enabled by the sufficient surgical field without new neurological deficits. Three-dimensional reconstructed images based on the postoperative computed tomography scans demonstrated the appropriate extent of the osseous drilling.

2019 ◽  
Vol 80 (S 04) ◽  
pp. S363-S364
Author(s):  
Ciro Vasquez ◽  
Alexander Yang ◽  
A. Samy Youssef

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.


2019 ◽  
Vol 1 (2) ◽  
pp. V3
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Duarte N. C. Cândido ◽  
Wladimir O. Melo ◽  
Marcio S. Rassi ◽  
...  

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.


2019 ◽  
Vol 80 (S 04) ◽  
pp. S355-S357
Author(s):  
Robert T. Wicks ◽  
Xiaochun Zhao ◽  
Celene B. Mulholland ◽  
Peter Nakaji

Abstract Objective Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma. Design, Setting, and Participant A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma (Fig. 1A, B). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology. Outcome/Result Maximal total resection of the tumor was achieved (Fig. 1B, C), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection (Fig. 2) is shown in the video. Conclusion Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates.The link to the video can be found at: https://youtu.be/Mds9N1x2zE0.


2006 ◽  
Vol 177 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Marie Pincemaille-Quillevere ◽  
Eric Buffetaut ◽  
Frédéric Quillevere

Abstract Since the 19th century, the Campanian and Maastrichtian continental deposits of southern France have yielded numerous dinosaur remains [Le Loeuff, 1991; 1998; Buffetaut et al., 1997; Laurent et al., 1991; Allain and Suberbiola, 2003]. The ornithopod remains that have not been referred to the hadrosaurids have been systematically attributed to Rhabdodon [Buffetaut and Le Loeuff, 1991; Buffetaut et al., 1996; Garcia et al., 1999; Pincemaille-Quillévéré, 2002]. This genus, initially named by Matheron [1869] after its discovery in the lower Maastrichtian of La Nerthe (Bouches-du-Rhône), belongs to the Euornithopoda [sensu Sereno, 1999]. Rhabdodon represents the most common element of the dinosaur assemblages from the late Cretaceous of southern France [e.g. Allain and Suberbiola, 2003]. Nevertheless, since the localities have only provided some fragmentary material [Pincemaille-Quillévéré, 2002], the global morphology of this dinosaur and its phylogenetic placement within the euornithopods are still debated. The cranial morphology of Rhabdodon is particularly poorly understood due to the rarity of cranial remains preserved in the localities of southern France [Matheron, 1869; Garcia et al., 1999; Buffetaut et al., 1999; Pincemaille-Quillévéré, 2002]. Buffetaut et al. [1999] first mentioned the discovery of a braincase (M4) referred to Rhabdodon, at Massecaps, a locality close to the village of Cruzy (Hérault, France). More recently, a new braincase (MN25) has been discovered at Montplô Nord, another locality close to Cruzy (specimens M4 and MN25 are conserved in the Museum of Cruzy). Both these localities have revealed a diverse and abundant vertebrate fauna suggesting a late Campanian to early Maastrichtian age [Buffetaut et al., 1999]. These braincases are described here in an attempt to detect potential autapomorphic characters in Rhabdodon, and compared to a more complete braincase of Tenontosaurus, an euornithopod from the Lower Cretaceous of North America, considered as the sister group of Rhabdodon [Weishampel et al., 1998; 2003; Garcia et al., 1999; Pincemaille-Quillévéré, 2002], in order to determine the potential differences and synapomorphies between the occiputs of the two genera. Finally, the braincases from Cruzy are compared to those of the other euornithopods described in the literature. Specimen M4 (figs. 1–4) is incomplete but exceptionally well preserved. This braincase belongs to a juvenile individual, as shown by the numerous visible suture lines between the different cranial elements. Specimen MN25 (fig. 5) is badly deformed and attributable to an adult individual. Until now, all the ornithopods from the Upper Cretaceous of southern France have been referred either to hadrosaurs or to Rhabdodon. The Hadrosauridae show a low nuchal crest and their exoccipitals meet and form a bar on the dorsal border of the foramen magnum, excluding the supraoccipital from this border. Specimens M4 and MN25 do not present any nuchal crest and the supraoccipital participates in the dorsal border of the foramen magnum. Both braincases M4 and MN25 are therefore attributable to Rhabdodon. Specimens M4 and MN25 have been compared to the occiput of a juvenile Tenontosaurus tilletti (fig. 6 : MCZ 4205, conserved in the Museum of Comparative Zoology, Harvard University). This reveals that Tenontosaurus and Rhabdodon share numerous characters : (1) the exoccipitals form the lateral borders of the foramen magnum, its ventral border being occupied by the basioccipital; (2) the occipital condyle is partly constituted by the exoccipitals, and in the same proportions; (3) the supraoccipital is rostrally oriented; (4) the suture line located between the prootic and the laterosphenoid shows the same outline; (5) the cresta prootica starts within the paroccipital process and extends onto the opisthotic; (6) the cresta prootica is transversal and non-horizontal; (7) the distribution of the cranial nerves is homologuous along the lateral surface of the braincase. Nevertheless, the braincase of Tenontosaurus differs from that of Rhabdodon in several significant respects : (1) the exoccipitals are dorsally connected, excluding the supraoccipital from the dorsal border of the foramen magnum; (2) two small dorsal humps are present at the level of the suture of the exoccipitals; (3) the supraoccipital is excluded from the dorsal border of the foramen magnum, which gives it a triangular shape; (4) the paroccipital processes are short, laterally flattened, and wing-shaped, and are more mediodorsally oriented than in Rhabdodon; (5) the cresta prootica follows a concave line and ends up on the prootic, at the level of the opening of the trigeminal nerve; (6) the external curve of the laterosphenoids is stronger; (7) the suture between the basioccipital and the opisthotic is very clear. The first of these unshared characters suggests that Rhabdodon belongs to Norman’s [1984] ‘hypsilophodontoid’ clade and Tenontosaurus to the more evolved ‘iguanodontoid’ clade. The fusion of the exoccipitals on the dorsal border of the foramen magnum, together with other cranial adaptations, may have reduced the stress caused by a more elaborate mastication. Rhabdodon appears to have had a more primitive type of mastication. The strip formed by the reunion of the exoccipitals is less expanded dorsoventrally in Tenontosaurus tilletti than in the ‘iguanodontoid’ and ‘hadrosauroid’ clades. Tenontosaurus may therefore represent an intermediate group between the ‘hypsilophodontoid’ and ‘iguanodontoid’ clades.


Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 945-954 ◽  
Author(s):  
Arnold H. Menezes ◽  
Kathleen A. Fenoy

Abstract OBJECTIVE Developmental remnants around the foramen magnum, or proatlas segmentation abnormalities, have been recorded in postmortem studies but very rarely in a clinical setting. Because of their rarity, the pathological anatomy has been misunderstood, and treatment has been fraught with failures. The objectives of this prospective study were to understand the correlative anatomy, pathology, and embryology and to recognize the clinical presentation and gain insights on the treatment and management. METHODS Our craniovertebral junction (CVJ) database started in 1977 and comprises 5200 cases. This prospective study has retrieval capabilities. Neurodiagnostic studies changed with the evolution of imaging. Seventy-two patients were recognized as having symptomatic proatlas segmentation abnormalities. RESULTS Ventral bony masses from the clivus or medial occipital condyle occurred in 66% (44/72), lateral or anterolateral compressive masses in 37% (27 of 72 patients), and dorsal bony compression in 17% (12 of 72 patients). Hindbrain herniation was associated in 33%. The age at presentation was 3 to 23 years. Motor symptoms occurred in 72% (52 of 72 patients); palsies in Cranial Nerves IX, X, and XII in 33% (24 of 72 patients); and vertebrobasilar symptoms in 25% (18 of 72 patients). Trauma precipitated symptoms in 55% (40 of 72 patients). The best definition of the abnormality was demonstrated by 3-dimensional computed tomography combined with magnetic resonance imaging. Treatment was aimed at decompression of the pathology and stabilization. CONCLUSION Remnants of the occipital vertebrae around the foramen magnum were recognized in 72 of 5200 CVJ cases (7.2%). Magnetic resonance imaging with 3-dimensional computed tomography of the CVJ provides the best definition and understanding of the lesions. Brainstem myelopathy and lower cranial nerve deficits are common clinical presentations in the first and second decades of life. Treatment is aimed at decompression of the pathology and CVJ stabilization.


2020 ◽  
Vol 2 (2) ◽  
pp. V13
Author(s):  
Satoshi Kiyofuji ◽  
Masahiro Shin ◽  
Kenji Kondo ◽  
Tsukasa Koike ◽  
Taichi Kin ◽  
...  

Cerebellopontine (CP) angle tumors are often resected via retrosigmoid craniotomy; however, sometimes cranial nerves (CNs) make their resection more complex. In such cases, the endoscopic transnasal approach can avoid such manipulations as delivering surgical instruments over CNs or peeling off CNs from the tumor, minimizing the risk of postoperative deficits. A 35-year-old man presented with a 37-mm cystic tumor in the right CP angle, and preoperative 3D fusion images revealed that multiple CNs (VII, VIII, and lower CNs) were running on the tumor posteriorly. The endoscopic transnasal approach enabled safe subtotal resection without causing neurological deficits, and the patient underwent stereotactic radiosurgery for the residual schwannoma.The video can be found here: https://youtu.be/xKLwdDsLpWA.


2008 ◽  
Vol 65 (8) ◽  
pp. 648-652
Author(s):  
Marko Markovic ◽  
Iva Berisavac ◽  
Vladimir Bojovic ◽  
Bojan Kostic ◽  
Vuk Djulejic

Background. Herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal with obliteration of the cerebellomedullary cistern is the primary feature of Arnold-Chiari type I malformation (ACM I). It is considered to be congenital malformation, although there have been reported cases of an acquired form. Case report. We presented a female patient, 45-year old, with ACM I without syringomyelia as a rare and unusual clinical image, as well as the effect of decompressive surgery in the treatment of this malformation. The patient was admitted to the Department of Neurosurgery with clinical signs of truncal ataxia worsening during the last six years. Moderate quadriparesis with predominant lower extremity involvement and the signs of the cranial nerves damages occured during the last seven months before admission, with progressive clinical course up to the date of admission. Neurosurgical treatment that included suboccipital medial craniectomy with resection of posterior arch C1 vertebrae and C2 laminectomy resulted in a significant clinical improvement and a much better quality of life. Conclusion. Posterior craniovertebral decompression with microsurgical reduction of the cerebellar tonsils and placement of an artificial dural graft is a treatment of choice in severe forms of ACM I without syringomyelia. .


2021 ◽  
Vol 1 (1) ◽  
pp. 58-61
Author(s):  
Neelima P ◽  
Ravi Sunder R

Vertebral column is made of 33 vertebrae named as cervical, thoracic, lumbar, sacral and coccygeal vertebrae. Axial skeleton comprises of skull and vertebral column. 12 pairs of cranial nerves and 31 pairs of spinal nerves exit from the central nervous system which control the entire body. Malformations or fusion of vertebrae could be one of the etiologies of nerve compression syndromes. Vital structures emerge out through intervertebral foramina extending from cervical to coccygeal vertebrae. Occipitalisation of atlas, the first cervical vertebra is one of the emergencies leading to wide spectrum of presentations like chronic neck pain or foramen magnum syndrome or unconscious state due to compression of medulla oblongata. During routine examination of skull bones while teaching, one skull was found to exhibit assimilation of atlas. Photographs were captured and compared with normal skull. Thorough examination revealed incomplete occipitalisation of atlas. The anterior arch was completely fused but the posterior arch was bifid showing a split. The styloid process on right side seemed to be long and very close leading to compression of structures of styloid apparatus in addition. On observation, it was found to be a male skull. Fusion of vertebrae may be a congenital anomaly due to maldevelopment of somites in forming vertebrae. Skeletal element of caudal 4th occipital somite forms the occipital bone and when it is fused with the proximal 1st cervical somite leads to occipitalisation of atlas. Acquired conditions like atlantoaxial subluxation, chiari malformations or cervical vertebral fusion or foramen magnum abnormalities have been associated with assimilation of atlas. The present study reports occipitalisation of atlas which is incomplete with a bifid posterior arch. Prevalence of such anomalies may form the differential diagnosis of chronic headache or myelopathies.


Author(s):  
Jaafar Basma ◽  
Dom E. Mahoney ◽  
Christos Anagnostopoulos ◽  
L. Madison Michael ◽  
Jeffrey M. Sorenson ◽  
...  

Abstract Introduction Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures—the asterion (A) and transverse process of the atlas (TPC1)—we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region. Methods We dissected six cadaveric heads (12 sides) to expose the posterolateral skull base, including the mastoid and suboccipital bone, TPC1 and suboccipital triangle, distal jugular vein and internal carotid artery, and lower cranial nerves in the distal cervical region. We inspected the A-TPC1 line before and after drilling the mastoid and occipital bones and studied the relationship of the sigmoid sinus trajectory and major muscular elements related to the line. We retrospectively reviewed 31 head and neck computed tomography (CT) angiograms (62 total sides), excluding posterior fossa or cervical pathologies. Bone and vessels were reconstructed using three-dimensional segmentation software. We measured the distance between the A-TPC1 line and sigmoid sinus at different levels: posterior digastric point (DP), and maximal distances above and below the digastric notch. Results A-TPC1 length averaged 65 mm and was posterior to the sigmoid sinus in all cadaver specimens, coming closest at the level of the DP. Using the transverse-asterion line as a rostrocaudal division and skull base as a horizontal plane, we divided the major surgical approaches into four quadrants: distal cervical/extreme lateral and jugular foramen (anteroinferior), presigmoid/petrosal (anterosuperior), retrosigmoid/suboccipital (posterosuperior), and far lateral/foramen magnum regions (posteroinferior). Radiographically, the A-TPC1 line was also posterior to the sigmoid sinus in all sides and came closest to the sinus at the level of DP (mean, 7 mm posterior; range, 0–18.7 mm). The maximal distance above the DP had a mean of 10.1 mm (range, 3.6–19.5 mm) and below the DP 5.2 mm (range, 0–20.7 mm). Conclusion The A-TPC1 line is a helpful landmark reliably found posterior to the sigmoid sinus in cadaveric specimens and radiographic CT scans. It can corroborate the accuracy of neuronavigation, assist in minimizing the risk of sigmoid sinus injury, and is a useful tool in planning surgical approaches to the posterolateral skull base, both preoperatively and intraoperatively.


2021 ◽  
Vol 9 (3) ◽  
pp. 41
Author(s):  
Li Li ◽  
Seidu A. Richard ◽  
Zhigang Lan ◽  
Yuekang Zhang

Introduction: Intracranial dermoid cysts are benign, ectopic squamous epithelial cysts often compose of dermal structures like hair follicles, sweat glands as well as sebaceous glands. This lesions constitutes about 0.5% of all intracranial neoplasms. Thus, the occurrence of a dermoid cyst in the posterior fossa is very rare. We report a rare case of intracranial dermoid cyst in posterior cranial fossa. Case Presentation: Our first case was a 32 years old woman who presented with headaches and dizziness with no nausea, vomiting or fever. CT scan revealed a mass at occipital cistern consistent with a cystic lesion. MRI also revealed an irregular lesion in the posterior part of the medulla oblongata with enhanced edges signifying calcifications. We attained total resection of the tumor in a piece meal approach via surgery. Histopathology confirmed dermoid cyst. Two years follow-up revealed no recurrence of the lesion and no neurological deficits. Conclusion: We advocate that, the goal in surgical decision-making should be safe and total resection while monitoring the cranial nerves with electromyographic and auditory brainstem responses.


Sign in / Sign up

Export Citation Format

Share Document