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Emrah Celtikci, Department of Neurosurgery, Pittsburgh Medical Center, Pennsylvania, USA, proposed another supratentorial approach for the resection of sickle meningioma, that is, the interhemispheric wedge anterior corpus callosum after the brain sickle approach
through anatomical, imaging and clinical studies.
Article was published in the July 2021 issue of the journal
Operativ Neurosurgery.
- Excerpted from the article chapter
【Ref: Celtikci E, et al.
Oper Neurosurg (Hagerstown).
2021 Jul 15; 21(2):48-56.
doi: 10.
1093/ons/opab095.
】
Research background
Sickle meningiomas are rare meningiomas, accounting for approximately 0.
3%-1.
1% of all intracranial meningiomas and 2%-8%
of tumors in the cerebellar behind-therapeutic notch area.
Surgical approaches to the retrocapitular notch area of the cerebellum include the occipital interhemisphere approach, the suprateum-intorial cerebellar approach (SIA), and a combination of these two approaches, the bilateral occipital transcerebellar toscap/transcerebral sickle approach
.
Other surgical routes include the parietal-occipital interhemispherical/transcorpus callosum approach, the posterior transcortical approach through the angular gyrus/lateral ventricles, and the posterior inferior temporal approach
.
Some authors emphasize the importance of considering the location of
deep veins for surgical approaches.
In general, meningiomas with upward displacement of the internal cerebral veins and Galen veins are more suitable for the supratebellar approach, while those with downward displacement of the deep venous system have a more advantageous
supratentorial approach.
Given that there is no bridge vein in the occipital segment of the superior sagittal sinus, the interhemisphere approach to the occipital lobe is the most commonly used supratentorial approach to the post-notch space
.
The anterior hemisphere transcorpus callosum compression approach (AITA) has recently been proposed as an approach to the treatment of sickle meningiomas, with the advantage of not having a pontogram vein anteriorly, but requiring an incision of the posterior part of the corpus callosum
.
Emrah Celtikci, Department of Neurosurgery, Pittsburgh Medical Center in Pennsylvania, USA, proposed an alternative supratentorial approach for the resection of sickle meningioma, that is, interhemispheric precuneus retrosplenial transfalcine approach through anatomical, imaging and clinical studies.
IPRTA）
。
Article was published in the July 2021 issue of the journal
Operativ Neurosurgery.
Research methods
bridge veins.
At the same time, 20 patients were selected to confirm the feasibility of IPRTA.
Determine bony markers, the bridging veins in the area, and the anterior and posterior boundaries
of the approach.
Surgical passage widths, i.
e.
, venous septum and length
, were compared for several midline approaches.
Study results
The authors found that IPRTA provides the shortest distance to reach the anterior and posterior boundaries of the cerebellar behind-the-scenes notch; Moreover, it is the only way
to directly observe the anterior and posterior boundaries of meningiomas at the sickle junction.
In all anatomical specimens and patients, a minimum interval of 30 mm
was found between the parietal anterior vein (APV) and the posterior parietal vein (PPV) of the hemisphere.
The authors used the IPRTA approach to operate on 4 clinical patients, all of whom successfully removed the sickle junction meningioma.
Complications included mild paresthesias in the lower extremities in 2 patients and temporary foot ptosis
in 1 patient.
A limitation of the study was the relatively small
number of cadaver specimens and CT images of patients.
Although the authors found sufficient surgical space (>30 mm) between the anterior and posterior bridge veins, the sample was rather small and could not draw consistent conclusions
.
Therefore, the authors strongly recommend that a detailed radiological study be performed prior to surgery to determine the most favorable access
between the patient's anterior and posterior parietal veins.
From the results of the study, the surgical passage becomes wider
when APV is drained into the posterior central vein.
Conclusion of the study
The authors believe that IPRTA provides the shortest and most direct access for sickle meningioma resection, visualization of most critical structures in this area
.
The septum between the grafting veins provides sufficient room for this approach, but there is also a potential risk
of injury to the sensory cortex.
The authors emphasize that due to the limitations of venous variation and specimen volume, detailed preoperative imaging evaluation is essential
to identify deep vein structures and determine the ideal channel between the bridge veins.
