Orbitozygomatic surgery by Dr. Juan Carlos Fernández-Miranda
En SurgSchool, the number one app for online surgical training, we present a new case of high educational value: the microsurgical resection of a Anterior clinoid meningioma involving the internal carotid artery (ICA), made by the Dr. Juan Carlos Fernández-Miranda, Director of Neurosurgery at Stanford University and a world leader in skull base surgery.
Presentation of the case
The patient, 34 years old, came with severe visual loss in the left eye y right temporal campimetric defectThe MRI showed a anterior clinoid meningioma invasion of the optic canal y significant vascular encasement of the ICA, which posed a surgical challenge of maximum complexity.
Surgical approach: orbitozygomatic with clinoidectomy
El Dr. Fernández-Miranda opted for a orbitozygomatic approach, which allows wide exposure of the skull base and early access to critical neurovascular structures.
Key steps in the surgery include:
- Orbitozygomatic craniotomy and dissection of the middle fossa.
- Section of the meningo-orbital band and complete exposure of the anterior clinoid process.
- Clinoidectomy and optic canal drilling, facilitating decompression of the optic nerve.
- Opening of the dura mater and Sylvian fissure, exposing branches of the middle cerebral artery and the tumor.
- Progressive tumor debulking with ultrasonic aspirator and extracapsular dissection.
- Identification and preservation of critical structures: supraclinoid carotid artery, optic nerve, anterior and middle cerebral arteries, and perforating arteries.
- Release of the optic canal tumor and complete resection around the ICA.
Clinical results
The patient presented a dramatic visual improvement in the left eye and normalization of the right visual field in the postoperative period. The images confirmed a complete tumor resection, without additional neurological deficits.
Educational importance
This case represents a masterful example of complex skull base surgery, which combines clinoidectomy techniques, microsurgical vascular control and optical decompression.
For neurosurgeons and residents, this video is available at SurgSchool offers:
- Strategies for managing clinoid meningiomas with vascular involvement.
- Safe techniques of exposure and protection of the optic nerve.
- Advanced use of orbitozygomatic approaches and middle fossa dissections.
- Demonstration of how to preserve critical branches of the internal carotid and anterior cerebral arteries.
The case of Dr. Juan Carlos Fernández-Miranda reaffirms the relevance of orbitozygomatic approach in clinoid meningiomas with ICA involvement, offering the best chance of complete resection and visual recovery.
Access the complete surgery in SurgSchool
This case is available in the app SurgSchool, featuring high-definition video, surgeon commentary, and a didactic approach to help neurosurgeons and residents learn the most advanced techniques in skull base surgery.
