September 01, 2015
Let's review techniques for a section of Parafalcine Meningioma. This is a 55 year-old female who presented with severe headaches and was known to suffer from this midsize Parafalcine Meningioma. There is no involvement of the superior sagittal sinus. As expected, the sinus is pasted on MRV evaluation. My strategy involved a right-sided power satchel craniotomy using the interhemispheric fissure, disconnecting the base of the larger portion of the tumor away from the falx, followed by cutting the port of the falx affected by the tumor and the livery of the contralateral portion of the tumor into our resection cavity. A lumbar drain was used at the beginning of the procedure to facilitate entry into the interhemispheric fissure and dissection through there out. Here's the right-sided power satchel craniotomy. One of the veins was very much adherent to the dura along the anterior port of our exposure. I adjust my dural incision to preserve the lumen of the vein. It was cutting parallel to the route, to the vein. If any of the lakes in the era of the power sagittal super sagittal sinus are inadvertently entered or their sinus is slightly torn, I use a suture to primarily seal and repair the defect. Well more doing is quite effective for CSF drainage and decompression. Because of early brain decompression, I can mobilize the tumor and the brain, and devascularize the tumor from the falx effectively. This is a very important maneuver because devascularization will lead to efficient debulking of tumor without significant bleeding. The pericallosal arteries were exposed along the interior boarder of the tumor early on. Their early exposure will keep them out of harm's way. Here's continuation of the disconnection or the base of the tumor on the right side of the falx. Relatively vascular tumor. Now that the tumor is devascularized I simply go ahead and dissect the tumor from the surrounding peal surfaces. Piece of cottonwood is used to protect the brain from the force of suction. The tumor is mobilized away from the brain. That piece of the tumor was removed. Piece of cottonwood is now covers the brain. As I proceed with removal of the portion of that falx affected by the tumor. 15 blade knife is utilized to create a small incision within the falx. You can see the extent of the base of the tumor. Blonde hook is used to make sure there's no adherence to the falx as the scissors are used to complete the falx scene window. A Carlin blade is used to cut the falx toward the surgeon. Next, you can see the contralateral portion of the tumor that is readily deliverable into our resection cavity. That's why I approach the tumor from the larger side where the dissection can be more difficult. Now, obviously this part of the tumor is readily devascularized by transection of their portion of the falx at here in the tumor. Here's the anterior part of the falx. Additional pieces of falx affected by the tumor also resected and the remainder of the falx is heavily quite isolated. Small residual tumor is apparent. You can see pericallosal arteries and the calcium marginal artery. Final result, and the postoperative MRI demonstrated. Complete removal of the mass without any complicating features. Thank you.
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