September 03, 2014
Here is another video discussing resection of medial sphenoid wing meningiomas. This is an 82 year-old female who presented with progressive memory and speech difficulties. MRI evaluation revealed the left-sided medial sphenoid wing meningioma relatively of medium size. T2 MRI revealed significant evidence of edema. The tumor again is centered over the clinoid process in the medial aspect of the sphenoid wing. She underwent a left fronto-temporal craniotomy. Here's the frontal lobe. Gentle elevation or the frontal lobe allowed devascularization of the base of the tumor over the latter aspect of the sphenoid wing. I followed the contours of the wing to devascularize the tumor as aggressively as possible while staying short of the optic nerve. Next, the tumor was debulked, disconnected from the frontal lobe. Here's removal of the tumor from the subfrontal area. Here's the connection of the tumor from the temporal lobe and the tentorium. The tumor's capsule was circumferentially isolated from the surrounding cerebrovascular structures. Here's the carotid artery found over the medial pole of the tumor. Some of the vessels directly going into the tumor were coagulated and cut. Their identity was carefully inspected before they were transected. Here's the optic nerve, carotid artery. Tumor was disconnected from its base. The tumor does not appear to infiltrate the optic canal. Here's the final product. The dura was carefully curetted to assure aggressive tumor removal and minimize the future risk of recurrence. Again, the carotid artery, optic nerve, the base of the tumor over the dura of the anterior clinoid process. No residual tumor is apparent. Postoperative MRI demonstrates complete removal of the mass without any untoward findings. Thank you.
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