TY - JOUR
T1 - Large falcine meningioma fed by callosomarginal branch successfully removed following contralateral interhemispheric approach
AU - Barajas, Ramon F.
AU - Sughrue, Michael E.
AU - McDermott, Michael W.
N1 - Funding Information:
Acknowledgments The first author thanks Bethany Carlson M.S. R.N. for her helpful comments regarding this manuscript. This work was supported by National Institutes of Health National Center for Research Resources Grant TL1 RR024129-01. Computer animation provided by Kenneth Probst, an employee of the Department of Neurological Surgery at the University of California, San Francisco.
PY - 2010/3
Y1 - 2010/3
N2 - We report the case of a highly vascular facline meningioma removed following surgical ligation of a large callosomarginal feeding branch via a contralateral interhemispheric approach. Successfully addressing this vessel via a contralateral interhemispheric approach prior to any debulking allowed for en bloc Simpson Grade 1 tumor removal with minimal blood loss and short term tumor control without evidence of recurrence at 2 year follow up. A 56 year old man presented with first time generalized tonic-clonic seizure. Imaging revealed a right sided 5 cm falcine meningioma. The patient underwent pre-operative embolization of feeding branches, however, the most significant supply, arising from the right callosomarginal artery, could not be occluded. A bipartite frontotemporal craniotomy was performed. From a left sided interhemispheric approach the pericallosal and callosomarginal arteries were identified and the large callosomarginal tumor feeding branch were occluded using a straight Yasargil aneurysm clip. From the right the superior sagital sinus was ligated anteriorly and posteriorly. The sinus, falx, and adherent tumor were then removed en bloc. We present the case of a highly vascular falcine meningioma with a large callosomarginal feeding branch which was successfully occluded using surgical clipping of this vessel via a contralateral interhemispheric approach. This case provides an excellent example of one approach to directly dealing with large, deep interhemispheric feeding vessels unsuitable for embolization. A 3D animation of the surgical approach is provided for instructional purposes.
AB - We report the case of a highly vascular facline meningioma removed following surgical ligation of a large callosomarginal feeding branch via a contralateral interhemispheric approach. Successfully addressing this vessel via a contralateral interhemispheric approach prior to any debulking allowed for en bloc Simpson Grade 1 tumor removal with minimal blood loss and short term tumor control without evidence of recurrence at 2 year follow up. A 56 year old man presented with first time generalized tonic-clonic seizure. Imaging revealed a right sided 5 cm falcine meningioma. The patient underwent pre-operative embolization of feeding branches, however, the most significant supply, arising from the right callosomarginal artery, could not be occluded. A bipartite frontotemporal craniotomy was performed. From a left sided interhemispheric approach the pericallosal and callosomarginal arteries were identified and the large callosomarginal tumor feeding branch were occluded using a straight Yasargil aneurysm clip. From the right the superior sagital sinus was ligated anteriorly and posteriorly. The sinus, falx, and adherent tumor were then removed en bloc. We present the case of a highly vascular falcine meningioma with a large callosomarginal feeding branch which was successfully occluded using surgical clipping of this vessel via a contralateral interhemispheric approach. This case provides an excellent example of one approach to directly dealing with large, deep interhemispheric feeding vessels unsuitable for embolization. A 3D animation of the surgical approach is provided for instructional purposes.
KW - Callosomarginal artery
KW - Contralateral interhemispheric approach
KW - Falcine meningioma
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U2 - 10.1007/s11060-009-9994-1
DO - 10.1007/s11060-009-9994-1
M3 - Article
C2 - 19718501
AN - SCOPUS:77949275225
SN - 0167-594X
VL - 97
SP - 127
EP - 131
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 1
ER -