Resection of Skull Base Meningioma With Extensive Extracranial Extension: 2-Dimensional Operative Video.

Abstract

Jugular foramen meningiomas are rare tumors with distinguishing clinical, radiological, and surgical considerations.1,2 They involve the lower cranial nerves, invade the temporal bone, occlude jugular vein and sigmoid sinus, and involve internal carotid and vertebral arteries. Their location is prime for an extensive extracranial cervical extension. They might reach giant size with extension from the Meckel cave in the cerebellopontine angle to the carotid bifurcation in the neck while exhibiting only minor symptoms. Surgical morbidity is associated mainly with lower cranial nerves deficits. Radical surgical removal has been considered impossible with vascular encasement and is associated with a considerable risk of vascular injury. With careful and thorough preoperative evaluation, including evaluating the adequacy of the cerebral collateral and applying an appropriately tailored skull base approach,3 radical tumor resection can be achieved with the expectation of a good outcome.3,4 Meticulous microsurgical dissection of the tumor involving the internal carotid artery in the neck would permit radical resection without vascular damage and avoiding the need for vascular reconstruction.5 We demonstrate this technique in a 47-year-old female patient presented in the year 2007 having a giant jugular fossa tumor with extensive neck extension who consented to surgery. Image at 2:23 reused with permission from Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg. 2002;97(6):1356-1366, by permission from JNSPG. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_vf9v0duk"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}