Update: Posterior clinoid process meningioma

Posterior clinoid process (PCP) intracranial meningiomas are extremely rare lesions and comprise about 0.7% of central skull base meningiomas

Meningiomas arising from the PCP can compress the pituitary stalk anteriorly, the oculomotor nerve laterally or infero-laterally and encase the C1-C2 segment of the internal carotid artery (ICA) or its perforators and branches 1).

Classification

Clinical and radiological features or characteristics of posterior clinoid process (PCP) meningiomas have rarely been described because of their extreme scarcity and terminological confusion.

These tumors are often referred to as “dorsum sellae” or “upper clivus meningiomas” 2) 3) 4) 5).

Geng et al. subdivided the dorsum sellae meningiomas into two groups

Type 1 (dorsum sellae, inferior third ventricle type)

Type 2 (dorsum sellae, third ventricular type), depending upon the site and direction of growth 6) 7) 8).


Lesions in this region are primarily of two anatomic types:

Centrally placed meningiomas located between the two PCPs and arising from the dorsum sellae or upper clival region – which should be referred to as dorsum sellae meningioma or upper clivus meningiomas.

Eccentrically placed meningiomas centered on the PCP are true PCP meningiomas 9).

Takase et al., suggests that PCP meningioma may be characterized by the anterior displacement of internal carotid artery, and infero-laterally shifted posterior communicating artery, and homonymous hemianopsia, a distinctive clinical feature 10).

Differential diagnosis

Hongo et al., report a case of an osteochondroma in the posterior clinoid process that occurred in a 43-year-old man with trochlear nerve palsy. Although the potential preoperative diagnoses based on computed tomography and magnetic resonance imaging included other intracranial tumors such as calcified meningioma, thallium-201 single-photon emission computed tomography effectively differentiated osteochondroma from those possibilities 11).

Treatment

In close proximity to these lesions are the perforators from the internal carotid artery (ICA) and the oculomotor nerve, which need to be considered while deciding the appropriate surgical approach.

Strategies in the surgical intervention have not been well established. Moreover, the proximity to important neurovascular structures, including optic chiasm, internal carotid artery (ICA), pituitary stalk, and oculomotor nerve, can be difficult to predict preoperatively, making their surgical excision more challenging.

Differentiation between the dorsum sellae/upper clival meningiomas and the PCP meningiomas may have important implications in selecting the surgical approach 12). One of the key issues in PCP meningioma surgery is preservation of the optic nerve. Unlocking the optic nerve by anterior clinoidectomy and dissection, the falciform ligament is the important step to preserve vision for larger tumors 13).

Approaches

Various surgical approaches have been described to approach the PCP to minimize complications, and to improve the extent of resection.

These include the extradural trancavernous-transellar approach described by Dolenc 14).

A frontotemporal or pterional approach, presigmoid transpetrosal approach, and a transzygomatic subtemporal approach 15).

In the frontotemporal and pterional approach, there is direct access to the tumor through the optico-carotid and carotico-oculomotor corridors, but the perforators, which are pushed anteriorly by the tumor, are at risk of injury or vasospasm. A two stage approach, combining retrosigmoid suboccipital corridor to devascularize the tumor, followed by total excision of the tumor by frontotemporal route, has also been described 16) 17).

The transzygomatic subtemporal approach is anatomically a good technique as it allows the dural attachment of the tumor to be coagulated first, followed by piecemeal tumor excision. However, temporal lobe retraction may be hazardous and occasional venous infarcts have been reported 18). The transcavernous approach described by Dolenc is also potentially hazardous for the cranial nerves and the ICA 19).

Complications

Complication with the perforators is also hazardous of these challenging surgeries than anterior clinoid region meningiomas for their specific neuroanatomical structures and might not be feasible to avoid even with additional techniques and critical monitoring. A combination and multi-staged-surgical approach can be options of tailor-made surgical strategy in cases with tumor adhesion to the perforators 20).

Case reports

The tumor described by Nakamura et al. was anteriorly placed, arising from the upper clivus and should be labeled as dorsum sellae or upper clival meningioma 21).

Geng et al. discussed eight cases of dorsum sellae meningiomas (types 1 and 2) but did not mention the exact site of origin 22) 23) 24).

2016

Takase et al., report two surgical cases of PCP meningioma and discuss the appropriate assessment of preoperative features and surgical strategies with review of the literature 25).

2015

Sodhi et al., describe a basal frontotemporo-orbito-zygomatic approach with splitting of the sylvian fissure to resect an eccentrically placed PCP meningioma.

The approach allowed access through the carotico-optic corridor, and between the carotid artery and the oculomotor nerve, as well as the anterior subtemporal approach. This provided an additional surgical trajectory allowing direct access to the PCP posterior to the perforating vessels without temporal lobe retraction.

A basal frontotemporo-orbito-zygomatic approach with splitting of the sylvian fissure is a safe approach to resect an eccentrically placed PCP meningioma 26).

2013

Shukla et al. reported a patient as posterior clinoid meningioma, which was eccentric and centered over the PCP 27).


1) , 5) , 8) , 15) , 17) , 24) , 27) Shukla D, Gangadharan J, Kakati A, Devi BI. Posterior clinoid process meningioma. Clin Neurol Neurosurg. 2013 Aug;115(8):1517-9. doi: 10.1016/j.clineuro.2012.12.007. Epub 2013 Jan 11. PubMed PMID: 23313105.
2) , 14) , 18) , 19) Dolenc VV, Skrap M, Sustersic J, Skrbec M, Morina A. A transcavernous-transsellar approach to the basilar tip aneurysms. Br J Neurosurg. 1987;1:251–9.
3) , 6) , 22) Geng SM, Zhang JT, Zhang LW, Wu Z, Wang ZC. Optimal microsurgical treatment of dorsum sellae meningioma. Chin Med J (Engl) 2009;122:1857–61.
4) , 7) , 16) , 23) Nakamura M, Samii M. Surgical management of a meningioma in the retrosellar region. Acta Neurochir (Wien) 2003;145:215–9.
9) , 12) , 26) Sodhi HB, Singla N, Gupta SK. Posterior clinoid meningioma: A case report with discussion on terminology and surgical approach. Surg Neurol Int. 2015 Feb 11;6:21. doi: 10.4103/2152-7806.151261. eCollection 2015. PubMed PMID: 25722927; PubMed Central PMCID: PMC4338485.
10) , 13) , 20) , 25) Takase H, Kawasaki T, Tateishi K, Yokoyama TA, Murata H, Kawahara N. Characteristics and surgical strategies for posterior clinoid process meningioma: two case reports and review of the literature. Neurosurg Rev. 2016 Aug 24. [Epub ahead of print] PubMed PMID: 27553846.
11) Hongo H, Oya S, Abe A, Matsui T. Solitary Osteochondroma of the Skull Base: A Case Report and Literature Review. J Neurol Surg Rep. 2015 Jul;76(1):e13-7. doi: 10.1055/s-0034-1387189. Epub 2015 Mar 2. PubMed PMID: 26251790; PubMed Central PMCID: PMC4520987.
21) Nakamura M, Samii M. Surgical management of a meningioma in the retrosellar region. Acta Neurochir (Wien) 2003;145:215–9.

New Book: Cerebral Herniation Syndromes and Intracranial Hypertension

Cerebral Herniation Syndromes and Intracranial Hypertension (Updates in Neurocritical Care)

Cerebral Herniation Syndromes and Intracranial Hypertension (Updates in Neurocritical Care)

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When the brain suffers an injury, the effects can be delayed and unpredictable. Cerebrospinal fluid can slowly build up, causing dangerously high levels of intracranial pressure (ICP), and the brain tissue can be displaced into adjacent compartments, resulting in cerebral herniation syndrome (CHS). Within the burgeoning field of neurocritical care, experts are just beginning to understand the nuanced, sometimes counterintuitive relationship between ICP and CHS.
Written by leading researchers who also have extensive first-hand clinical experience treating brain injury patients, Cerebral Herniation Syndromes and Intracranial Hypertension provides an up-to-date guide to this complex aspect of neurocritical care. Drawing from expertise gained working in high-volume medical centers, the book’s contributors reveal that there is no universal metric for gauging acceptable levels of intracranial pressure. Instead, they demonstrate the best practices for offering patients individualized care, based on their specific conditions and manifest symptoms.
Bringing together internationally-renowned neurocritical care experts from a variety of neurology, critical care, surgery, and neurosurgery disciplines, this volume takes a comprehensive look at a complicated issue. A concise, practical, and timely review, Cerebral Herniation Syndromes and Intracranial Hypertension offers vital information for all medical personnel concerned with improving neurocritical patient care.

Product Details

  • Published on: 2016-08-22
  • Original language: English
  • Number of items: 1
  • Dimensions: 9.00″ h x .81″ w x 6.00″ l, .0 pounds
  • Binding: Hardcover
  • 200 pages

Editorial Reviews

About the Author

MATTHEW KOENIG, MD, FNCS is an associate medical director of neurocritical care at The Queen’s Medical Center, and an assistant professor of medicine at the University of Hawaii John A. Burns School of Medicine in Honolulu. He is the author of dozens of peer-reviewed articles and book chapters, and is also co-editor of the book Neurological Consultations in the ICU.

Endovascular Neurosurgery Through Clinical Cases

Endovascular Neurosurgery Through Clinical Cases
By Aristotelis P. Mitsos

Endovascular Neurosurgery Through Clinical Cases

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Endovascular neurosurgery is a recently introduced but rapidly evolving medical field, which uses minimally invasive interventions to treat major life-threatening vascular lesions of the Central Nervous System. Although its history counts less than 15 years of worldwide acceptance, it has rapidly displaced the traditional open neurosurgical techniques, being nowadays the first treatment choice for brain aneurysms and vascular malformations. Thus, the experience of each neuroendovascular center and performer is invaluable, offering the base for learning and teaching the new generation of interventionalists as well as for the evolvement of the method itself.

This book presents the basic principles of endovascular neurosurgery starting from clinical cases. Through this close-to-clinical-reality-process, the reader will be able to more thoroughly understand the pathophysiology of the brain and spine vascular lesions as well as the decision-making strategy, related to the indications, endovascular methods and results, finding suggestions and solutions to his/her clinical questions and problems. Besides chapters devoted to CNS vascular embryology and anatomy, clinical cases organized in groups based on the treated lesions are introduced: ruptured and unruptured cerebral aneurysms of the anterior and posterior circulation, side-wall and bifurcation aneurysms, arteriovenous malformations (AVM), dural arteriovenous fistulae (dAVF), arterial stenosis and angioplasty as well as spinal vascular lesions. A separate chapter is devoted to the organization and necessary equipment of the angio room and the department offering neuroendovascular service.

This volume will be of interest to neurosurgeons, interventional neuroradiologists, vascular surgeons, neurologists and ICU physicians as well as health care providers who are involved in the diagnosis and management of the vascular lesions of the brain and spine.


Product Details

  • Published on: 2016-08-19
  • Released on: 2016-08-19
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.00″ h x .46″ w x 7.01″ l, .0 pounds
  • Binding: Paperback
  • 180 pages

Editorial Reviews

Review

“This book presents personal case illustrations of commonly used endovascular procedures for various arteriovenous malformations of the brain and the spine. … It is appropriate for interventional neuroradiologists and neurosurgical trainees as well as established practitioners. It also can be helpful for neurologists and diagnostic neuroradiologists. … The book is handy, to the point, and carries the weight of years of experience.” (Ramsis Farid Ghaly, Doody’s Book Reviews, May, 2015)

From the Back Cover

Endovascular neurosurgery is a recently introduced but rapidly evolving medical field, which uses minimally invasive interventions to treat major life-threatening vascular lesions of the Central Nervous System. Although its history counts less than 15 years of worldwide acceptance, it has rapidly displaced the traditional open neurosurgical techniques, being nowadays the first treatment choice for brain aneurysms and vascular malformations. Thus, the experience of each neuroendovascular center and performer is invaluable, offering the base for learning and teaching the new generation of interventionalists as well as for the evolvement of the method itself.

This book presents the basic principles of endovascular neurosurgery starting from clinical cases. Through this close-to-clinical-reality-process, the reader will be able to more thoroughly understand the pathophysiology of the brain and spine vascular lesions as well as the decision-making strategy, related to the indications, endovascular methods and results, finding suggestions and solutions to his/her clinical questions and problems. Besides chapters devoted to CNS vascular embryology and anatomy, clinical cases organized in groups based on the treated lesions are introduced: ruptured and unruptured cerebral aneurysms of the anterior and posterior circulation, side-wall and bifurcation aneurysms, arteriovenous malformations (AVM), dural arteriovenous fistulae (dAVF), arterial stenosis and angioplasty as well as spinal vascular lesions. A separate chapter is devoted to the organization and necessary equipment of the angio room and the department offering neuroendovascular service.

This volume will be of interest to neurosurgeons, interventional neuroradiologists, vascular surgeons, neurologists and ICU physicians as well as health care providers who are involved in the diagnosis and management of the vascular lesions of the brain and spine.

About the Author
Aristotelis P. Mitsos is a Lt Colonel of Hellenic Army and a Consultant Neurosurgeon with an expertise in Endovascular Neurosurgery. He has a Master of Science Degree from the University of Oxford, UK (2006) in Endovascular Neurosurgery and Interventional Neuroradiology; he is the Head of the Neuroendovascular Department in 401 Athens General Army Hospital, offering neuroendovascular services in more than 150 patients every year.

Book: Tumors of the Central Nervous System, Volume 13: Types of Tumors, Diagnosis, Ultrasonography, Surgery, Brain Metastasis, and General CNS Diseases

Tumors of the Central Nervous System, Volume 13: Types of Tumors, Diagnosis, Ultrasonography, Surgery, Brain Metastasis, and General CNS Diseases

Tumors of the Central Nervous System, Volume 13: Types of Tumors, Diagnosis, Ultrasonography, Surgery, Brain Metastasis, and General CNS Diseases

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Coverage in this book includes diagnosis, intraoperative ultrasonography, cell counting, and brain metastasis. It examines a range of tumor types, including neuroblastoma, medulloblastoma, meningioma, and chordoma.


Product Details

  • Published on: 2016-08-19
  • Released on: 2016-08-19
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.00″ h x .83″ w x 7.01″ l, .0 pounds
  • Binding: Paperback
  • 308 pages

Editorial Reviews

 

“The purpose is to provide the latest literature on aggressive primary and metastatic brain tumors, in addition to their surgical and nonsurgical management. The audience includes practicing neurosurgeons, neurologists, oncologists and radiation oncologists, neuroradiologists, neuropathologists, and neuroscientists. … This volume chooses some challenging topics in brain tumors, rendering good reviews and discussing both conventional teaching and new concepts.” (Ramsis Farid Ghaly, Doody’s Book Reviews, November, 2014)

“This is the 13th volume in a whole series on the pathology, radiographic history, diagnosis, and treatment of malignant and nonmalignant brain tumors. As part of the series, this is an outstanding discussion of brain tumors including surgery, radiation, and chemotherapy of CNS tumors. I recommend this book to neurooncologists and neurosurgeons.” (Joseph J. Grenier, Amazon.com, July, 2014)

From the Back Cover

Volume 13: Pineal, Pituitary, and Spinal Tumors is organized in six sections, for convenience and quick access to critical information. Section I, Types of Tumors includes a chapter on molecular characterization of Embryonal tumors, a chapter on diagnosis of metastatic oligodendroglioma using fine-needle aspiration cytology, one covering intra-arterial chemotherapy of oligodendroglial tumors and another on the role of cyclooxygenase-2 in the development and growth of Schwannomas, and others, closing with a chapter on trigeminal neuralgia with cerebellopontine angle tumors.

Section II, Diagnosis, includes two chapters on cell counting in histopathologic slides of tumors. Section III offers three chapters which discuss aspects of intraoperative ultrasonography. Section IV covers brain tumor surgery, and Section V surveys Brain Metastasis. The final section offers a wide-ranging review of General Diseases, with chapters on, among others, Alexander Disease; Lipoma; Transplantation of human umbilical cord blood mononuclear cells in cases of neonatal hypoxic-ischemic brain damage; and a chapter discussing the use of mobile phones and brain cancer risk in children.

Like its twelve predecessors in the series, this volume merits distinction for its thorough approach, its roster of 78 distinguished contributors representing 14 different countries and its detailed examination of leading-edge technology and methods.

New Book: Surgery of the Spine and Spinal Cord: A Neurosurgical Approach

Surgery of the Spine and Spinal Cord: A Neurosurgical Approach

Surgery of the Spine and Spinal Cord: A Neurosurgical Approach

Price: $199.00

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This book offers essential guidance on selecting the most appropriate surgical management option for a variety of spinal conditions, including idiopathic problems, and degenerative disease. While the first part of the book discusses the neuroanatomy and biomechanics of the spine, pain mechanisms, and imaging techniques, the second guides the reader through the diagnostic process and treatment selection for disorders of the different regions of the spine, based on the principles of evidence-based medicine. I.e., it clearly explains why a particular technique should be selected for a specific patient on the basis of the available evidence, which is carefully reviewed. The book identifies potential complications and highlights technical pearls, describing newer surgical techniques and illustrating them with the help of images and accompanying videos. Though primarily intended for neurosurgeons, the book will also be of interest to orthopaedic surgeons, specialists in physical medicine, and pain specialists.


Product Details

  • Published on: 2016-08-16
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.28″ h x 1.50″ w x 7.17″ l, .0 pounds
  • Binding: Hardcover
  • 752 pages

About the Author

Dr Erik van de Kelft graduated magna cum laude as a Doctor in Medicine, Surgery, and Obstetrics from the University of Antwerp, Belgium, in 1985. After 2 years of training in general surgery at the General Hospital Stuivenberg, he specialized in neurosurgery under the supervision of Drs. J.J. Martin and P. Selosse at the University Hospital, Antwerp (UZA). His training included periods in Montpellier, France and La Timone Hospital in Marseille, where he focused on pediatric neurosurgery. After successfully completing his training in 1993, Dr. van de Kelft became a permanent staff member in the Neurosurgery Department at the UZA and also a consultant at the Maria Middelares General Hospital in Sint-Niklaas. During this period, he earned a Doctorate in Biomedical Sciences, writing his doctoral thesis on the molecular genetics of malignant brain tumours. Since 1999 he has been a permanent member of the Neurosurgery Department of the Niklaas Hospital, Sint Niklaas, and the OLV (Our Lady) Hospital in Aalst; he is also a neurosurgery consultant at St. Jozef Hospital, Bornem. Dr. van de Kelft is especially known for his expertise in back surgery and in the surgical treatment of facial pain. He is the author of 50 articles in peer-reviewed journals and a regular speaker at international conferences.

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