February 10, 2015
Let's review the techniques for resection of a simple frontal convexity meningioma. This is a 52 year old male presented with a seizure and underwent MRI evaluation, which revealed alertive really large convexity right from meningioma. He underwent a right frontal craniotomy and incision was mapped over the right temporal parietal area so that a generous craniotomy is elevated and the affected part of the dura is also thoroughly removed. This is the extent of the craniotomy tack of stitches were placed due to the large size of the craniotomy middlemen injure artery appears to be feeding their tumor and it was quite isolated initially. Next a wide margin is left behind and the entire part of the dura that can be affected by the tumor is incised. Resection of this white margin decreases the likelihood of future tumor occurrence. Navigation can guide the extent of neural excision during transection of the dura obviously the middleman artery that is feeding the tumor is also automatically disconnected. Is a circumferential disconnection of the dura around the margins of the tumor. Next the dura reflected over the tumor mass so the exact margins of the tumor or identified, you can see these dura margins are relatively clean. Dural adhesions are not uncommon. You can see the margin of the tumor interfacing with the brain peel surfaces. There is a vein potentially infiltrated by the tumor. Next the arachnoid and peel adhesions at the brain tumor interface are dissected. All the emphasized vessels are carefully protected. Tumor capsule may be quite regulated so that the tumor is reduced mobilizing it away from the brain peel surfaces. After the superficial aspect of the tumor capsule has been dissected, the deep proportion of the tumor, are also disconnected from the surrounding arachnoid bands. Arachnoid planes are respected as much as possible. So the peel surfaces are all so protected. Now that the superficial arachnoid bands are released, I use thin ribbons of cotton patties or telfa to gently mobilized tumor away from the brain. Again tumor is ruled away from the brain. And a piece of telfa is inserted between the brain and the tumor. Here is the specific maneuver. As dissection continues these cotton patties are also advanced to the deep apex of the mass, this maneuver is repeated circumferentially. Obviously there are areas where the peel surfaces are violated aggressive use of the suction device on the brain parenchyma is avoided forceps are used to disconnect the adhesions between the apex of the tumor and the brain immaculate hemostasis is performed telfa pieces and carotenoids are removed piece of allograph dura or preferably a piece of pre cranium is used to reconstruct the dural defect. Here's the usual thrombin solution for achieving hemostasis. Postoperative MRI demonstrated complete remove the mass without any complicating feature. Thank you.
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