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Endoscopic treatment of cerebrospinal fluid pathway obstructions. Neurosurgery ;62 Suppl 3 Endoscopic transventricular third ventriculostomy through the lamina terminalis. J Neurosurg ; Transventricular fenestration of the lamina terminalis: The value of a flexible endoscope: Technical note.

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Endoscopic and Microsurgical Anatomy of the Upper Basal Cisterns

Minim Invasive Neurosurg ; Subfrontal endoscopic fenestration of lamina terminalis: An anatomical study. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: Prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr ; Microscopic supraciliary approach for terminal laminotomy for treatment of hydrocephalus: A preliminary report of eight cases.

Turk Neurosurg ; Suprapineal recess: An alternate site for third ventriculostomy?

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Case report. The extended pterional approach described above was used in all cases. The progressive elevation of the tumor from the cribiform plate and planum sphenoidale reveals small arteries that irrigate the meningioma. In order to decrease intraoperative bleeding, early interception of these feeding arteries is essential. The tumor capsule is bipolar coagulated medial to the ipsilateral ON and the tumor is debulked.

If dissection of the tumor from the perforators is tenacious, it is better to leave a shell of the tumor on the vessel wall than to risk the rupture of the artery. The basal dura with tumor invasion is bipolar coagulated and striped off, and the underline hypertrophic bone is partially drilled away without entering the sphenoidal sinus Simpson Grade 2. The dissection must start in the planum sphenoidale or tuberculum sellae, bipolar coagulating the feeding arteries.

Internal tumor debulking is achieved by piecemeal resection. The tumor located posterolaterally to the ON and medial to the internal carotid artery is carefully dissected through the optic carotid triangle and removed from beneath the ON.

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A diamond ball must be used for drilling the roof of the optic canal when the tumor extends through it. Copious irrigation is mandatory to prevent damage to the ON by the heat. The meningioma is exposed and carefully dissected from the inferior and medial aspect of the ON with minimal manipulation. In the immediate postoperative period, patients were submitted to contrast-enhanced computed tomography scans.

The mean follow-up period was 69,4 months range, months. Thereafter, patients were reexamined or at least interviewed by telephone. Operative mortality was 2. A 77 years-old female died 3 months after surgery due to an acute subdural hematoma. One patient died 18 months after discharged from hospital because of a pulmonary carcinoma.

Other patient affected by obesity and cardiac failure died 2 years after the operation.

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There were 2 patients with postoperative Cerebro Spinal Fluid CSF leakage who returned to the operating room for repair. Surgical outcome and follow up are summarized in Table 3. Various approaches have been described in the literature to treat anterior fossa meningiomas, including the pterional 1 , 7 , 10 , 11 , 13 , 17 , 20 , 22 , 26 , uni 3 , 5 , 17 , 23 , 24 or bilateral subfrontal 8 , 11 , 21 , 27 and cranial base approaches 9 , 2 , 5 , 16 , 25 ,, The surgical technique presented here is modified from one described earlier by Yasargil and others 1 , 7 , 10 , The extended pterional approach has a number of advantages over the bifrontal craniotomy: provides the shortest distance to the tuberculum sellae, the early release of CSF from the basal cisterns, allows brain relaxation and minimizes frontal lobe retraction.

Early exposure of the ON and chiasm provides protection of the visual system. The identification of the internal carotid artery improves the ability to dissect the anterior cerebral artery and its branches, allowing protection of these vessels 1 , 7 , 10 , 11 , 13 , 14 , 17 , 19 , 20 , 22 , 26 , 28 , 29 , The disadvantage of the pterional approach is the inadequate visualization of the undersurface of the ipsilateral ON and chiasm. However we can circumvent this problem by moving the surgical microscope medially, associated with lateral tilt of the operative table.

This surgical nuances technique was not published before. Nakamura et al.

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They claimed that the frontolateral and pterional approaches provide remarkable improvement compared with the bifrontal approach. To decrease tumor recurrence, some authors recommend cranial base approaches such as uni or bilateral orbital osteotomy and cranial base drilling and reconstruction 2 , 5 , 8 , 16 , Some surgeons stated that Simpson Grade I resection including dural attachment and underlying tumor-infiltrated bone is critical in preventing future recurrence. In published microsurgical series, the recurrence rate for TSMs and OGMs, with a follow-up period ranging from 2 to 9.

Cushing 6 reported an operative mortality of As a result of the refinements of microsurgical techniques, death rates had declined 11 , 18 , 20 , 23 , 26 , In this present series, the surgical mortality occured in one patient 2. Al-Mefty 25 and Solero et al. In our series, 18 individuals Nowadays, the preservation of vision is an important goal of treatment. Fahlbusch and Schott 10 and Symon 18 found tumors smaller than 3 cm to be associated with better visual outcomes than tumors larger than 3 cm in diameter.

In this sample, improvement of vision occured in Improvement or stabilization of vision has been reported in We can conclude that the extended pterional transsylvian approach has many advantages. It is simple and fast, while preserving normal anatomy. The early exposure of the ON and chiasm provides protection of the visual system. In this paper we show that we can achieve a low mortality and morbidity, with a high rate of GTR, fewer complications, and low recurrence rates with the extended pterional transsylvian approach.

Our study confirms that the pterional approach and its variants are effective to remove anterior fossa meningiomas. Suprasellar and olfactory meningiomas: report on a series of personal cases.

Acta Neurochir Wien. Olfactory groove meningiomas: Surgical technique and follow-up review. Arq Neuropsquiatr. Arq Neuropsiquiatr. Olfactory groove meningiomas. Meningiomas: a comprehensive text. Sign in via your Institution Sign in. Purchase Subscription prices and ordering Short-term Access To purchase short term access, please sign in to your Oxford Academic account above.

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