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Frontal Parafalcine Meningioma

January 05, 2015

Transcript

This video refers to resection of a large frontal parafalcine meningioma. This is an 85 year-old female who presented with confusion. MRI evaluation revealed a sizable parafalcine meningioma along the anterior falcine area. There is some evidence of edema associated with this tumor. She underwent a generous Souttar incision on the left side behind her line. So that a left sided anterior parasagittal craniotomy can be completed. Here's a superior sagittal sinus, left frontal lobe. The interhemispheric fissure was entered. The base of the tumor was devascularized from the left aspect of the falx. I essentially followed the contours of the falx. You can see brain relaxation via the lumbar drain. Just the surface of the falx. Numerous feeding vessels were apparent through the falx. Please note that changing the orientation of the microscope in this case. And this anterior falx. The cap of the brain that was overlying the tumor is being mobilized. I used carotenoid patties to mobilize the brain away from the tumor. This maneuver is quite effective in protecting the brain from the suction device. I placed the carotenoid patty over the surface of the tumor, and then mobilized the tumor away from the brain while inserting the carotenoid patty at the level of the tumor brain interface. Next is aggressive debulking of the tumor. A large piece of tumor is being removed. Again, the carotenoid patties are further advanced around the circumference of the tumor. You can see I pushed the tumor away from the brain and advanced these carotenoid patties so that the brain surface is protected. As expected, the PO surfaces are invaded. Here is additional carotenoid patties on the top of the older ones. Now I'm inserting these patties at the base of the tumor in continuation of this method while mobilizing the enucleated tumor capsule away from the brain. Microsurgical techniques are used for dissection of the tumor capsule away from the vessels. Last piece of the tumor is being delivered and the portion of the falx affected by the tumor can be removed or heavily coagulated to minimize the risk of future recurrence, and here's the postoperative MRI revealing adequate resection of the tumor without any complicating features. Thank you.

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