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Purely endoscopic removal of a parasagittal/falx meningioma

Acta Neurochirurgica volume 158, pages 451–456 (2016)Cite this article

Abstract

Background

Endoscopic techniques are an integral part of the neurosurgical armamentarium with a growing list of indications. We describe the purely endoscopic removal of an atypical parasagittal meningioma in a patient who could not undergo standard craniotomy due to severe scalp atrophy following childhood irradiation for tinea capitis.

Methods

A 68-year-old man in good general health presented with a parasagittal meningioma that recurred following subtotal removal and adjuvant fractionated stereotactic radiosurgery (FSR). The scalp above the tumor location was very diseased and precluded a regular craniotomy for tumor removal. A 4-cm craniotomy was made in the midline forehead, where the skin was normal. A rigid endoscope was advanced under neuronavigation through the interhemispheric fissure, which provided good access with limited retraction, until the tumor was encountered at a depth of 7–8 cm. Two surgeons performed the surgery using a “four-hands technique”. The tumor was removed and the insertion area was resected and coagulated.

Results

The surgery was uneventful, with no coagulation or transection of major veins. A subtotal resection was achieved, and the patient recovered with no neurological deficit.

Conclusions

Safe resection of parasagittal meningiomas with a purely endoscopic technique is feasible. This option needs further exploration as an alternative strategy in patients with severely atrophic scalp skin that greatly increases the risk of significant healing complications with calvarian craniotomy

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Acknowledgments

We wish to thank Shifra Fraifeld, a Medical Writer in the Department of Neurosurgery, for her editorial contribution during manuscript preparation.

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Affiliations

  1. Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel, 91120

    Sergey Spektor, Emil Margolin & Samuel Moscovici

  2. Department of Otolaryngology, Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, 91120

    Ron Eliashar

Authors
  1. Sergey Spektor
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  2. Emil Margolin
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  3. Ron Eliashar
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  4. Samuel Moscovici
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Corresponding author

Correspondence to Sergey Spektor.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required and no identifiable information about the patient is included in the article; however, the patient has consented to the submission of this manuscript to the journal.

Funding

No funding was received for this research.

Conflicts of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Spektor, S., Margolin, E., Eliashar, R. et al. Purely endoscopic removal of a parasagittal/falx meningioma. Acta Neurochir 158, 451–456 (2016). https://doi.org/10.1007/s00701-015-2689-9

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  • DOI: https://doi.org/10.1007/s00701-015-2689-9

Keywords

  • Atypical meningioma
  • Endoscopic neurosurgery
  • Irradiation in childhood
  • Parasagittal/falx meningioma
  • Radiation-induced meningioma
  • Tinea capitis