January 11, 2016
Let's review the basic principles for resection of convexity meningiomas and more specifically, a lateral temporal meningioma. This is a 35 year old female who presented with progressive growth of her Temporal Meningioma, as demonstrated here. The characteristic imaging features of a Meningioma is evident. The dural tail is apparent. The resection should include removal of the portion of the dura affected by the tumor. And left front temporal craniotomy was completed. You can see the incision. That is relatively generous to the size of the tumor in order to allow removal of the affected dura to minimize the risk of future recurrence and achieve a desirable Simpson grade resection. Following completion of the craniotomy, the dura was incised around the base of the tumor. I usually prefer to use lumbar drain if possible. The early brain decompression often avoids the tight brain during drilling and minimized it through a scuff subarachnoid hemorrhage, as demonstrated here. The base of the tumor was heavily cauterized before dural opening to devascularize the tumor aggressively. The middle meningeal artery branches are likely to be the main feeding vessels to the tumor. The affected dura is obviously being resected generously beyond the margins of the base of the tumor. The veins are also preserved. Microsurgical techniques are used to dissect the adherent peer to the margin of the tumor. Micro scissors dissect the arachnoid bands adherent to the tumor capsule. An important maneuver is using the carotenoid patties to wipe their brain away from the tumor as the tumor is being mobilized out of its cavity. Obviously, this technique is primarily applicable to convexity tumors. You can see that the carotenoid patty protects the brain from the suction device. Coagulation shrinks the tumor. Here is another demonstration of this technique as the tumor is being mobilized out of its cavity. Obviously, brain attraction is minimized. Here is the resection cavity after removal of the tumor. All the veins are protected. Generous resection of the affected dura is again demonstrated. A piece of allograft dura was used to cover that dural defect. Post operative MRI demonstrates reasonable removal of the tumor. Thank you.
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