SURGICAL VIDEO
Endoscopic Endonasal Focal Transclival-Medial Condylectomy Approach for Resection of a Foramen Magnum Meningioma: 2-Dimensional Operative Video Juan M. Revuelta Barbero, MD∗ , Alaa S. Montaser, MD∗ ‡ , Mostafa Shahein, MD∗ , André Beer-Furlan, MD§ , Bradley A. Otto, MD∗ ¶ , Ricardo L. Carrau, MD∗ ¶ , Daniel M. Prevedello, MD∗ ¶ ∗ Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio; ‡ Department of Neurological Surgery, Ain Shams University, Cairo, Egypt; § Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; ¶ Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio
Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy145
Correspondence: Daniel M. Prevedello, MD, Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, N-1049 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. E-mail:
[email protected]
The endoscopic endonasal approach (EEA) provides direct access to foramen magnum meningiomas; however, it often requires extensive exposure including septal flap elevation with septum removal, complete sphenoidotomy, and panclivectomy. We present a case of a 54-yr-old-female with an incidental foramen magnum lesion followed up with serial imaging who presented 10 mo later with progressive neck discomfort and episodes of dizziness, with confirmed tumor progression and further brainstem compression. A focal transclival EEA with medial condylectomy was
performed preserving the upper two-thirds of the clivus, the nasal septum, and the sphenoid sinus. Gross total removal of a meningioma WHO Grade-1 was achieved with dura resection on the majority of the tumor (Simpson 2). Closure was achieved with a random pedicled inverted V nasaopharyngeal flap. There were no complications, all symptoms improved, and no recurrence was seen in 12 mo of follow-up. IRB approval was neither required nor saught for this single case report. The patient gave informed consent.
KEY WORDS: Foramen magnum meningioma, Endoscopic endonasal approach, Transclival, Nasalpharyngeal flap Operative Neurosurgery 0:1–2, 2018
Received, September 14, 2017. Accepted, June 4, 2018.
DOI:10.1093/ons/opy145
Disclosures Dr Carrau is a consultant for Medtronic. Dr Prevedello is a consultant for Medtronic and Stryker, and has received honorarium from Leica Microsystems,
and has a royalty agreement with KLS-Martin. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
OPERATIVE NEUROSURGERY
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