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Globular Lateral Sphenoid Wing Meningioma

August 13, 2016

Transcript

This is a nice, straightforward case of a lateral sphenoid wing meningioma. This is a 32 year old male who presented with a single seizure. MRI evaluation revealed a sizeable lateral sphenoid meningioma. There is minimal or no bone of the area that is affected by the tumor. There's no high proptosis. Of importance is the section of the dura that is affected by the tumor, away from the bulk of the tumor itself. During the exposure, the craniotomy has to be generous so that the entire segment of the dura affected by any tumor is removed. There is minimal or no edema around this mass. A very generous left frontotemporal craniotomy was completed. The lateral aspect of this sphenoid wing was drilled away. Following epidural hemostasis, as you can see a generous piece of the dura was incised, the edges of the dura were inspected for any evidence of residual tumor, edges appear quite clean. Here's the tumor itself. Next, the base of the tumor is aggressively devascularized all the way to the level of the medial extent of the base. You can see the bleeding from the middle meningeal arteries, feeding the tumor. I continue to stay on the dura and follow the surface of the dura to devascularize the tumor. Now I'm reaching the other side of the tumor. Here's the dura of the medial sphenoid wing. The tumor is now completely revascularized, and it's base disconnected. Next, the tumor is dissected away from the neurovascular structures, based on the size of the tumor, it may need to be first debulked. In this case the tumor is relatively moderate size. I attempted to gently mobilize the tumor away from the brain and create dissection planes using the cartoon art patties. Arachnoid membranes are respected. You can see the use of micro forceps to dissect the arachnoid bands away from the tumor. Surface of the mass is coagulated. Following circumferential disconnection of the tumor, the mass is extracted. Obviously any adhesion to the MCA branches should be sharply dissected. Further inspection reveals the part of the dura, again, along the lateral aspect of this sphenoid wing that is infiltrated by the tumor, the dura over the medial sphenoid wing is coagulated to decrease the chance of tumor recurrence. The part of the dura over the lateral spheroid wing that can be safely removed is resected. Obviously the part of the dura that extends into the superior orbital fissure is left intact. Additional coagulation of the edges of the dura performed. And here's the post-operative MRI, which revealed gross total resection of the tumor without any complicating features. Thank you.

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