Journal of Neurological Surgery. Part B, Skull Base
Georg Thieme Verlag KG
image
Retrosigmoid Transmeatal Approach with 360-Degree Drilling of the Internal Auditory Canal for the Resection of Intracanalicular Meningioma
Volume: 80, Issue: Suppl 3
DOI 10.1055/s-0039-1677858
  • PDF   
  • XML   
  •       

Highlights

Notes

Abstract

Introduction  Vestibular schwannomas are the most common lesions occupying the internal auditory canal (IAC); however, almost in 4 to 5% of meningiomas, metastases, cysts, lipomas, and cavernous malformations have been found in this location, mimicking schwannomas. Even though cerebellopontine angle (CPA) meningiomas with the involvement of the IAC are frequently encountered, the presence of a primary intracanalicular meningioma is rare.

Objective  To show the technical nuances of the retrosigmoid-transmeatal approach to successfully achieve gross total resection (GTR) with preservation of facial and auditory function.

Case Report  We present a left intracanalicular meningioma on a 60-year-old man with history of tinnitus and hearing loss. Magnetic resonance imaging (MRI) showed a left intracanalicular lesion completely obliterating the IAC and with minor extension to the CPA cistern, with the vestibulocochlear complex dislocated posteriorly, initially diagnosed as a Hannover's T2 vestibular schwannoma. The patient underwent a left retrosigmoid approach, and during the exposure of the lesion, the diagnosis of a meningioma became evident. The transmeatal phase of the approach was modified with a wide opening of the canal, including the anterior wall. Closure was performed using a muscle graft, duramater flap, and fibrin glue.

Results  GTR was achieved and the patient developed a mild facial palsy (House–Brackmann grade III) which completely recovered within 3 months.

Conclusions  The retrosigmoid transmeatal approach is suitable to achieve GTR in intracanalicular meningiomas. Some modifications of the approach intended for vestibular schwannomas are necessary and may be performed during the procedure.

The link to the video can be found at: https://youtu.be/A9OXRFIl1e8 .

Keywords
Ramina, Constanzo, da Silva, and Coelho Neto: Retrosigmoid Transmeatal Approach with 360-Degree Drilling of the Internal Auditory Canal for the Resection of Intracanalicular Meningioma

Notes

Conflict of Interest: None.
https://www.researchpad.co/tools/openurl?pubtype=article&doi=10.1055/s-0039-1677858&title=Retrosigmoid Transmeatal Approach with 360-Degree Drilling of the Internal Auditory Canal for the Resection of Intracanalicular Meningioma&author=Ricardo Ramina,Felipe Constanzo,Erasmo Barros da Silva,Maurício Coelho Neto,&keyword=posterior fossa meningioma,retrosigmoid transmeatal approach,intracanalicular meningioma,cerebellopontine angle tumor,&subject=Skull Base: Operative Videos,