A surgery by Dr. César Yanes-Guandique
El clinoidal meningioma It is an extra-axial tumor of the anterior base of the skull that can compromise critical structures such as the supraclinoid internal carotid artery, middle cerebral artery and the optic nerveIt presents a surgical challenge due to its close relationship with high-flow vessels and the frequent sphenoidal hyperostosis associated. In this surgery, the ascent to the app SurgSchool’s most emblematic landmarks, the Dr. Yanes-Guandique (The Savior) presents the management of a patient with left hemicranial headache and left ocular proptosis, without neurological deficit, in which imaging studies showed a left clinoidal meningioma with extension to the orbit and sphenoid wing.
Surgical approach
A frontotemporal orbitozygomatic approachThis technique allows for extensive exposure of the clinoidal region and the orbital cone. Prior to the dural opening, a mini-peel of the middle fossa to electrocoagulate the branches of the middle meningeal artery, reducing intraoperative bleeding.
During the resection, the following was performed tumor debulking with preservation of the main vessels—internal carotid artery and M3-M4 branches of the middle cerebral artery—respecting the capsular portions in close contact with them. orbital-optic decompression It allowed for the improvement of proptosis caused by bone hyperostosis.
Results and complementary treatment
The patient progressed favorably, with good orientation and cognitive function postoperatively. Given the tumor's adherence to critical structures, a plan was developed adjuvant radiotherapy to reduce the risk of recurrence.
Histopathological examination confirmed the diagnosis of WHO grade I meningioma.
Surgical relevance
Clinoidal meningioma is one of the most common tumors of the anterior lung base, predominantly affecting women over 50 years of age. Its management combines a meticulous resection with the use of advanced craniobasal approaches, such as the orbito-zygomatic, which facilitate neurovascular preservation and allow optimization of resection without increasing morbidity.
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