This document outlines information about sphenoid wing meningiomas (SWM), including:
- Background on SWM classification and locations of hyperostosis
- Causes of hyperostosis including tumor cell activity and bone stimulation
- Presentation of SWM such as headaches, visual changes, and nerve deficits
- Workup involving imaging like CT/MRI and surgical planning considerations
- Treatment including options for medical management or surgical resection via approaches like pterional or orbitozygomatic to remove tumor and resect bone
Before embarking on an approach, the surgeon should be familiar with both the ventricular anatomy and the options for optimally Accessing lesions in third ventricle is a surgical challenge because of its difficult corridor as well as deeper location, need of neural incision, preservation of vascular, thalamus and hypothalamus and likely risk of fornix injury.
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
Craniopharyngioma is thought to arise from ectodermally derived epithelial remnants of rathke’s pouch and there craniopharyngeal duct.
Neoplastic transformation of cells derived from tooth primordia give rise to adamantinomatous craniopharnygioma, whereas
such transformation in cells derived from buccal mucosa primodia give rise to papillary type
Surgical approach to thalamus explained in details their surgical anatomy and lesion, Preop post op results with different surgical approach for thalamic lesions
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Pineal gland is essentially an extra axial midline structure lying at the roof of dienchephalon rostral to the quadrigeminal cistern surrounded by important neurovascular structure, occurring in the geometric center of brain with same depth of trajectory had made the surgery in this region a formidable challenge to neurosurgeons, however radical resection must be the goal in selected pathologies, if not pure germ cell tumor.
Before embarking on an approach, the surgeon should be familiar with both the ventricular anatomy and the options for optimally Accessing lesions in third ventricle is a surgical challenge because of its difficult corridor as well as deeper location, need of neural incision, preservation of vascular, thalamus and hypothalamus and likely risk of fornix injury.
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
Craniopharyngioma is thought to arise from ectodermally derived epithelial remnants of rathke’s pouch and there craniopharyngeal duct.
Neoplastic transformation of cells derived from tooth primordia give rise to adamantinomatous craniopharnygioma, whereas
such transformation in cells derived from buccal mucosa primodia give rise to papillary type
Surgical approach to thalamus explained in details their surgical anatomy and lesion, Preop post op results with different surgical approach for thalamic lesions
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Pineal gland is essentially an extra axial midline structure lying at the roof of dienchephalon rostral to the quadrigeminal cistern surrounded by important neurovascular structure, occurring in the geometric center of brain with same depth of trajectory had made the surgery in this region a formidable challenge to neurosurgeons, however radical resection must be the goal in selected pathologies, if not pure germ cell tumor.
meningioma tumors presentation include definition, causes, symptoms, and treatment options
prepared by Abbas Wael Abbas
supervised by Dr Jawad Ziyadah ( neurosurgeon)
TUMORES DE LA CAPA MENINGOTELIAL
SON DEL 13 AL 26% DE LAS NEOPLASIAS INTRACRANEALES
DELECION DEL CROMOSOMA 22q
INMUNOHISTOQUIMICA:
VIM, EMA, CEA, R. Progesterona
MENINGIOMA ATIPICO KI67; 7.2%
MENINGIOMA ANAPLASICO KI 67; 14.7%
KI67 >O IGUAL A 4.2; ALTO
EL HALLAZGO DE INVASION CEREBRAL ES INDICADOR DE RECURRENCIA FRECUENTE (GRADO II OMS).
Overview of role of imaging in different intraconal and extraconal pathologies including infective,inflammatory and neoplastic pathologies.Also included is insight into anatomy,trauma,post operative imaging and certain miscellaneous disorders
Chronic Otitis Media - Squamosal type ( UG)AlkaKapil
Chronic Otitis Media - Squamosal / atticoantral/ unsafe Type
Theories of cholesteatoma
cholesteatoma
levenson's criteria
congenital cholesteatoma
classification of cholesteatoma
sade's classification of retraction of pars tensa
Toss classification of pars flaccida retraction
cholesterol granuloma
clinical features of Squamosal CSOM
Complications of COM/CSOM
Investigations - HRCT Temporal bone
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modified radical mastoidectomy
Radical mastoidectomy
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Emily Wise, Lund University
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About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
8. Causes of hyperstosis
vascular disturbances
Irritation of bone without actual invasion
previous trauma
bone production by tumor cells
osteoblastic stimulation of normal bone
bone growth is actually bone invasion by tumor cells.
9. Location of hyperstosis according
to frequency
lesser wing of the sphenoid bone
the greater wing of the sphenoid
The roof of the orbit
the inferior orbital fissure
the infratemporal fossa
the orbital rim
11. Pathophysiology
Head injury
Radiations
Harmonal (estrogen & progestrerone)
Genetic(loss of DNA on 22 chromose)
Androgen receptors(EGF,PDGF)
Viruses(Inoue-melnick virus )
Associated(gliomas,abscess & aneurysms)
12. Epidemiology
Race( Caucasians, Africans, African Americans, and
Asians)
Sex(Caucasians:75%women & 25% men.Africans show
an equal gender ratio).
Age(onset is 50 years increases thereafter)
Mortality(5years:87% & 10 years :58%)
13. Histologic findings
According to the World Health Organization (WHO)
in 1993, :
Benign (grade I) 6.9%: do not invade the brain
parenchyma.
Atypical (grade II) 34.6%: mitosis & increased
nuclear-cytoplasmic ratio.
Malignant (grade III and IV) 72.7%: greater mitosis,
necrosis, and invasion of brain parenchyma.
18. Workup
carotid arteriography
Tumor markers(C-PiB)
F-FDG PET scan
Preoperative visual testing
Intraoperative radiodetection of somatostatin
receptors is feasible, especially in bone-invasive
meningiomas
19. Medical treatment
Indications:
atypical and malignant meningiomas as an adjunct to
surgery
partially resected benign meningiomas
recurrence of meningiomas after a surgical resection.
21. Surgery
Indications:
size of the lesion >2.5cm
presence of signs or symptoms
patient’s condition
changes in the adjacent cerebral tissue (edema) on
imaging studies
surgeon’s experience.
22. Goal of surgery
radical excision of the tumor
resection of the lesion + the dural implant (1-cm
margin) + all hyperostotic bone.
24. Positioning
supine decubitus position
the head fixed in a three-pin head holder
head is slightly extension
rotated toward the contralateral side of the tumor
clinoidal tumors (between 30 and 40)
alar and pterional lesions(between 40 and 50)
25. Skin incision
a frontotemporal(pterional) curvilinear
starting at the root of the zygomatic arch, just 5 mm in
front of the tragus
runs vertically upward
Once it passes the ear, it is curved rostrally and
superiorly toward the ipsilateral frontal region.
26. Variation in skin incision
The midportion of incision can be extended backward,
especially in cases of pterional meningiomas with large
infiltration of the pterion.
If an orbitozygomatic (OZ) approach is required, it is
necessary to extend the incision vertically down to the
level of the ear lobe.
27.
28. Dissection of epicranial planes
superficial temporal artery
a posterior branch has to be coagulated
Dissection continues until the temporal fascia is
identified
Avoid wide separation between the temporal fascia
and the skin to avoid injury to the frontotemporal
branch of the facial nerve
29. Cont..
retrograde direction
two epicranial planes are created
skin and temporal fascia (fasciocutaneous flap)
temporal muscle alone (muscle flap)
30. Craniotomy & tumor resection
anatomic variety of the meningioma
Pterional
Alar
Clinoidal
En-plaque
31. Pterional
If hyperstosis:around the bone infiltration,bone flap of
around 5cm
If hyperstosis is absent:standard craniotomy
Section the tumor to elevate/remove the bone flap
Craneictomy:osseous tumor
33. Alar
frontotemporal craniotomy
extradural resection of the lesser wing of the sphenoid
bone.
Bone removal is continued until complete exposure of
the superior orbital fissure
The dura mater is then opened following a curvilinear
frontotemporal incision, reflecting the dural flap
forward
34.
35. clinoidal
a frontotemporal
resection of the sphenoid ridge
The superior orbital fissure is also completely opened
the posterolateral wall of the orbit is also removed in
case of orbital part of tumor
Anterior clinoidectomy:high speed drill+irrigation
Tumor involving optic nerve:curvillenier incision
37. Cont..
dural implants :coagulated
distal branches of the MCA
distal to proximal direction
initial debulking
Arterial dissection:proximally
The optic nerve
38.
39.
40. En-plaque
it is easier to expose the entire hyperostosis
pterional craniotomy is combined with an OZ
osteotomy,particularly when the lesion extends into
the inferior orbital fissure, infratemporal fossa, or orbit
41.
42.
43. Reconstruction & closure
resect a free dural margin
closure of the dura mater necessarily implies
application of a graft
Local tissue:aponeurotic galea, pericranium,or
temporal fascia
Distant tissues fascia:lata or abdominal fascia
Synthetic & biologic materials, but with a slightly
higher risk of infection.
Watertight closure is mandatory
44. Cont…
reconstruction of the pterional defect:
Autologous materials:split calvarial bone graft or ribs
synthetic materials:methylmethacrylate and titanium
45. Complications
Postoperative EDH:due to wide dural detachment
Csf leak
Seizures:if grow near epileptogenic areas
Cosmetic problems:inadequate reconstruction
Infection:prosthetic material,sinus opened
46. Results
In general, the short- and midterm follow-up results
after SWM resection are excellent
In the majority of cases,gross total resection is
accomplished with minimal morbidity.
However, the critical point is in long-term follow-up
because of the high risk of recurrence, which is
inversely proportional to the degree of tumor resection