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- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City, Mexico
- Department of Neurosurgery, Hellion Zambrano Hospital, Tecnologico de Monterrey, San Pedro Garza García, Mexico
- Tucuman Neurosurgical Innovation Lab, Faculty of Medicine, National University of Tucuman, San Miguel de Tucumán, Buenos Aires, Argentina
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Buenos Aires, Argentina
- Prevention and Health Promotion Undersecretary, National Health Ministry of Mexico, Mexico City, Mexico
- Department of Neurosurgery, Padilla Hospital of Tucuman, San Miguel de Tucuman, Argentina
Correspondence Address:
Rodrigo Uribe-Pacheco, Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City.
DOI:10.25259/SNI_911_2024
Copyright: © 2024 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: Rodrigo Uribe-Pacheco1, Marcos Vinicius Sangrador-Deitos2, Gerardo Yoshiaki Guinto-Nishimura1, Juan Francisco Villalonga3, Matias Baldoncini4, Ramiro López Elizalde5, Alvaro Campero6. Semi-sitting position and retrosigmoid approach for a large petroclival meningioma resection: 3-dimensional operative video. 27-Dec-2024;15:476
How to cite this URL: Rodrigo Uribe-Pacheco1, Marcos Vinicius Sangrador-Deitos2, Gerardo Yoshiaki Guinto-Nishimura1, Juan Francisco Villalonga3, Matias Baldoncini4, Ramiro López Elizalde5, Alvaro Campero6. Semi-sitting position and retrosigmoid approach for a large petroclival meningioma resection: 3-dimensional operative video. 27-Dec-2024;15:476. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13311
Date of Submission
29-Oct-2024
Date of Acceptance
23-Nov-2024
Date of Web Publication
27-Dec-2024
Abstract
Background: Petroclival meningiomas are still a neurosurgical challenge due to their proximity to cranial nerves and cerebral vasculature along the surgical corridor. The usual extension of large petroclival meningiomas is along the posterior fossa, frequently compromising and displacing adjunct cranial nerves such as the sixth and seventh-eight cranial nerve complex with brainstem compression, causing progressive neurological deficit and severe headache. The goal of sizeable petroclival meningioma surgery treatment is a maximal resection with preservation of neurological function. Several surgical approaches to the petroclival region have been described, and decisions depend on the valuable hearing, tumor origin, and lesion extension. Alongside, the semi-sitting position is a simple and feasible adaptation for several posterior fossa interventions, reducing venous hemorrhage and preventing venous air embolism.
Case Description: Hereby, we present the case of a 39-year-old female patient with progressive intermittent headache and right-sided hemiparesis secondary to a large petroclival meningioma. After a careful case study, surgical treatment was performed employing a retrosigmoid approach, aiming for the safest and maximal resection possible.
Conclusion: The retrosigmoid is an auditory sparing procedure that, with a semi-sitting position, provides direct visualization of the posterior fossa lateral triangles and the tumor and its dural implantation site with no blood and surgical view comprised of debris. This surgical video illustrates anatomical nuances and critical aspects of the retrosigmoid approach and semi-sitting position as safe and adequate access to complete resection and a favorable long-term clinical outcome. The patient consented to the procedure and the publication of his/her image.
Keywords: 3D operative video, Petroclival meningioma, Retrosigmoid approach, Semi-sitting position, Skull-base surgery
Video 1
Annotations[1-11]
00:40 - MRI findings compatible with petroclival meningioma[
00:50 - Tumor size, extension, and rationale for treatment and surgical approach decision.[
01:33 - Benefits of semi-sitting position[
01:43 - Surgical goal for petroclival meningioma with retrosigmoid approach[
08:45 - Disease background[
Ethical approval
Institutional Review Board approval is not required.
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.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
[Video 1]-Available on:
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
References
1. Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: A report of 33 patients. Neurosurgery. 1992. 31: 81328
2. Castellano F, Ruggiero G. Meningiomas of the posterior fossa. Acta Radiol Suppl. 1953. 104: 177
3. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: Surgical experience in 109 cases. J Neurosurg. 1996. 84: 208
4. Kankane VK, Misra BK. Petroclival meningioma: Management strategy and results in 21st century. Asian J Neurosurg. 2021. 16: 89-95
5. Martínez R, Vaquero J, Areitio E, Bravo G. Meningiomas of the posterior fossa. Surg Neurol. 1983. 19: 23743
6. Maurer AJ, Safavi-Abbasi S, Cheema AA, Glenn CA, Sughrue M. Management of petroclival meningiomas: A Review of the development of current therapy. J Neurol Surg B. 2014. 75: 358-67
7. Nguyen MP, Morshed RA, Cheung SW, Theodosopoulos PV, McDermott MW. Postoperative complications and neurological deficits after petroclival region meningioma resection: A case series. Oper Neurosurg. 2023. 25: 251-9
8. Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir (Wien). 1992. 118: 2732
9. Sekhar LN, Wright DC, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: Surgical approaches and pitfalls. J Neurooncol. 1996. 29: 24959
10. Singh N, Singh DK, Ahmad F, Kumar R. The retrosigmoid approach: Workhorse for petroclival meningioma surgery. Asian J Neurosurg. 2019. 14: 188-92
11. Wang X, Li M, Liang J, Liu Q, Ma T, Chen G. Monitoring of intracranial venous sinus pressure and prevention for venous air embolism during operation with semi-sitting position. J Clin Neurosci. 2020. 81: 220-6
