Surgery by Dr. Juan Casado and Dr. Miguel Barrera
En SurgSchool, the world's leading app for online surgical training, you will find surgeries narrated by international experts demonstrating advanced skull base techniques. One example is the management of the Cerebellopontine angle meningioma with extension to the internal auditory canal and jugular foramen, where the surgical approach must be meticulous to achieve complete excision while preserving neurological function.
Presentation of the clinical case
The patient presented left sensorineural hearing loss and mild instability. MRI showed a Cerebellopontine angle meningioma with extension to the IAC and jugular foramenGiven the age, the brainstem compression, and the possibility of improving hearing, surgery was decided upon.
Surgical technique: suprajugular transmeatal retrosigmoid approach
The procedure was performed by the Dr. Juan Casado and the Dr. Miguel Barrera.
- Initial opening: A left retrosigmoid craniectomy was performed and the cisterna magna was opened to expose the neurovascular structures.
- Microsurgical dissection: Cranial nerves and petrosal veins were identified and preserved, proceeding to coagulate the tumor base and separate it from the facial and vestibulocochlear nerve.
- Expanding access: the hard mother opened on the rock, expanding the approach towards the CAI (common in schwannomas) and jugular foramen by milling with a diamond bur.
- Tumor resection: Under neurophysiological control, the tumor was progressively removed, including the portion that extended to both foramina.
- Verification and control: Coagulation and complementary resection techniques were used to remove meningiomatous remnants adhered to the dura.
Postoperative results
The patient did not present facial paralysis postoperative. A transient dysphagia secondary to manipulation of lower nerves, which resolved within two weeks with swallowing rehabilitation. The final follow-up confirmed a complete excision of the injury.
Discussion
El suprajugular transmeatal retrosigmoid approach It is an effective alternative for meningiomas with simultaneous extension to the IAC and jugular foramen. It allows for wide surgical exposure, facilitates complete resection, and preserves neurological function.
Series published by Matsushima and Kohno (Tokyo University Hospital) support this technique for both meningiomas and lower nerve schwannomas, highlighting its safety and usefulness in complex skull base lesions.
Conclusion
The suprajugular transmeatal retrosigmoid approach offers a significant advantage in cerebellopontine angle meningiomas with multiple extension, allowing radical resection with low morbidity.
