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José Orlando de Melo Junior1, Luiz Antônio da Silva Lavradas Junior2, José Alberto Landeiro3
  1. Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro,
  2. Department of Neurosurgery, São José Hospital, Criciúma,
  3. Department of Neurosurgery, Antônio Pedro University Hospital, Fluminense Federal University, Niterói, Brazil.

Correspondence Address:
José Orlando de Melo Junior, Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.

DOI:10.25259/SNI_325_2022

Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: José Orlando de Melo Junior1, Luiz Antônio da Silva Lavradas Junior2, José Alberto Landeiro3. Anterior petrosal approach for petroclival solitary plasmacytoma. 13-May-2022;13:201

How to cite this URL: José Orlando de Melo Junior1, Luiz Antônio da Silva Lavradas Junior2, José Alberto Landeiro3. Anterior petrosal approach for petroclival solitary plasmacytoma. 13-May-2022;13:201. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11598

Date of Submission
07-Apr-2022

Date of Acceptance
27-Apr-2022

Date of Web Publication
13-May-2022

Abstract

Background: Primary solitary plasmacytoma (PSP) of the skull base is a rare localized monoclonal plasma cell dyscrasia with normal or low plasma cell infiltration. Differentiating from other skull base tumors based on radiologic findings is difficult due to nonspecific features. PSP has a better prognosis after surgical resection and adjuvant radiotherapy, unless the tumor progresses to multiple myeloma (MM). Nonetheless, 50–60% progress to MM within a median time of 2 years. Gross total resection (GTR) for PSP is controversial for improving overall survival. However, if the lesion is easily accessible, for example, nonskull base lesion, GTR is still advocated.

Case Description: A 67-year-old male patient presented with right occipital neuralgia and diplopia in the last year. Neurological examination revealed mild abducens paresis on the right side. Brain MRI scan showed a large petroclival bony extradural mass lesion on the right side, with homogeneous enhancement, extending from the dorsum sellae to the ipsilateral occipital condyle and involving the petrous carotid artery. Brain CT scan revealed an osteolytic lesion without intratumoral calcifications, sclerotic border, or periosteal reaction. Anterior petrosal approach was performed and GTR was achieved. The patient had good postoperative outcome and improvement of symptoms. Postoperative MRI revealed GTR. Total body imaging work-up and immunohistochemistry confirmed PSP.

Conclusion: Although the extent of resection in the outcome is controversial, maximal safe resection of skull base PSP should be considered to improve symptoms and quality of life.

Keywords: Anterior petrosal approach, Petroclival, Skull base, Solitary plasmacytoma

Video 1

Annotations[1-6]

00:00 – Introduction

00:46 – Case presentation

01:02 – Preoperative imaging

01:53 – Anterior petrosal approach, landmarks in a cadaver model

03:10 – Anterior petrosal approach, surgical steps

04:03 – Surgical video

06:23 – Postoperative imaging

06:29 – Outcome and conclusion.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Videos available on:

10.25259/SNI_325_2022

References

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2. Ma XJ, Li D, Wang L, Hao SY, Zhang LW, Zhang JT. Clinical features, radiological profiles, and surgical outcomes of primary intracranial solitary plasmacytomas: A report of 17 cases and a pooled analysis of individual patient data. J Neurooncol. 2019. 142: 263-72

3. Na’ara S, Amit M, Gil Z, Billan S. Plasmacytoma of the skull base: A meta-analysis. J Neurol Surg B Skull Base. 2016. 77: 61

4. Ozsahin M, Tsang RW, Poortmans P, Belkacémi Y, Bolla M, Dinçbas FO. Outcomes and patterns of failure in solitary plasmacytoma: A multicenter rare cancer network study of 258 patients. Int J Radiat Oncol Biol Phys. 2006. 64: 210-7

5. Schwartz TH, Rhiew R, Isaacson SR, Orazi A, Bruce JN. Association between intracranial plasmacytoma and multiple myeloma: Clinicopathological outcome study. Neurosurgery. 2001. 49: 1039-45

6. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol. 2004. 124: 717-26

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