Extent Of Bone Resection Research Articles

The use of a linear versus curvilinear oscillating saw blade for femoral head and neck excision surgery in cats.

To determine the effects of using either a linear or curvilinear oscillating, battery-powered saw blade on the extent of bone resection, bone fissure or fragmentation, soft tissue trauma, and surgical time for femoral head and neck excision (FHNE) in feline cadavers. 18 feline cadavers. Paired feline cadaveric femora were randomly assigned to either a 10 mm linear or 12 mm curvilinear blade for FHNE by 2 surgical residents. CT of each femur pre- and postoperatively were used to create 3D reconstructions of each femur. The residual remaining or excessively resected bone volume at the ostectomy site was compared to an "ideal" ostectomy line made by a board-certified surgeon on preoperative CTs. There were no significant differences in residual or excessive bone resection by a saw blade (P = .84), between surgeons (P = .65), or in surgery time (P = .39). When compared to the "ideal" ostectomy, the linear saw blade removed slightly less bone compared to the curvilinear blade, but was not statistically significant (P = .82). No fissures or fractures were noted; however, the curvilinear blade removed the entire lesser trochanter in 1 cadaver and the linear blade partially removed the greater trochanter in 1 femur and 2 lesser trochanters in 2 femora. The use of a curvilinear blade may be a viable option for performing FHNE in cats. In vivo studies are warranted to determine its efficacy in clinical cases where FHNE is performed and the incidence of complications postoperatively.

Bone resection methods in medication-related osteonecrosis of the jaw in the mandible: An investigation of 206 patients undergoing surgical treatment

Background /purposeThe standard treatment for medication-related osteonecrosis of the jaw (MRONJ) is surgery. However, reports on the appropriate extent of bone resection are few. We aimed to examine the relationship between the extent of bone resection and postoperative outcomes in patients with mandibular MRONJ. Materials and methodsThe clinical and imaging findings and treatment outcomes of 206 patients (258 surgeries) with mandibular MRONJ undergoing surgery were reviewed. Imaging findings were evaluated using computed tomography (CT) to sequestrum, osteolysis, periosteal reaction, and mixed-type osteosclerosis, and determine the extent of resection. In some cases, samples were taken from within the bone, and real-time polymerase chain reaction was used to confirm the presence of bacteria and fungi. ResultsThe three-year cumulative cure rate was 81.7%. Patients with malignant tumors showing no osteolysis and undergoing sequestrum removal or marginal mandibulectomy had significantly worse prognosis than those with osteoporosis showing osteolysis and undergoing segmental mandibulectomy. Furthermore, patients with residual osteolysis, periosteal reactions, and mixed-type osteosclerosis on CT were more likely to develop recurrence. Eleven patients showed no osteolysis on CT images. Patients with cancer administered with high-dose denosumab had significantly poorer prognosis. Bacteria and fungi were also detected in samples obtained from gap-type periosteal reaction and mixed-type osteosclerosis. ConclusionSurgery for MRONJ requires resection of the infected bone. Aside from the osteolysis area, the gap-/irregular-type periosteal reaction and mixed-type osteosclerosis must also be included in the resection area. Methods for determining the extent of bone resection in MRONJ without osteolysis are a future challenge.

A proposed classification system for presigmoid approaches: a scoping review.

The "presigmoid corridor" covers a spectrum of approaches using the petrous temporal bone either as a target in treating intracanalicular lesions or as a route to access the internal auditory canal (IAC), jugular foramen, or brainstem. Complex presigmoid approaches have been continuously developed and refined over the years, leading to great heterogeneity in their definitions and descriptions. Owing to the common use of the presigmoid corridor in lateral skull base surgery, a simple anatomy-based and self-explanatory classification is needed to delineate the operative perspective of the different variants of the presigmoid route. Herein, the authors conducted a scoping review of the literature with the aim of proposing a classification system for presigmoid approaches. The PubMed, EMBASE, Scopus, and Web of Science databases were searched from inception to December 9, 2022, following the PRISMA Extension for Scoping Reviews guidelines to include clinical studies reporting the use of "stand-alone" presigmoid approaches. Findings were summarized based on the anatomical corridor, trajectory, and target lesions to classify the different variants of the presigmoid approach. Ninety-nine clinical studies were included for analysis, and the most common target lesions were vestibular schwannomas (60/99, 60.6%) and petroclival meningiomas (12/99, 12.1%). All approaches had a common entry pathway (i.e., mastoidectomy) but were differentiated into two main categories based on their relationship to the labyrinth: translabyrinthine or anterior corridor (80/99, 80.8%) and retrolabyrinthine or posterior corridor (20/99, 20.2%). The anterior corridor comprised 5 variations based on the extent of bone resection: 1) partial translabyrinthine (5/99, 5.1%), 2) transcrusal (2/99, 2.0%), 3) translabyrinthine proper (61/99, 61.6%), 4) transotic (5/99, 5.1%), and 5) transcochlear (17/99, 17.2%). The posterior corridor consisted of 4 variations based on the target area and trajectory in relation to the IAC: 6) retrolabyrinthine inframeatal (6/99, 6.1%), 7) retrolabyrinthine transmeatal (19/99, 19.2%), 8) retrolabyrinthine suprameatal (1/99, 1.0%), and 9) retrolabyrinthine trans-Trautman's triangle (2/99, 2.0%). Presigmoid approaches are becoming increasingly complex with the expansion of minimally invasive techniques. Descriptions of these approaches using the existing nomenclature can be imprecise or confusing. Therefore, the authors propose a comprehensive classification based on the operative anatomy that unequivocally describes presigmoid approaches simply, precisely, and efficiently.

Guided versus freehand acromioplasty during rotator cuff repair. A randomized prospective study

IntroductionThere is no consensus on how to perform acromioplasty, particularly regarding the level and extent of bone resection, which depend on scapular and humeral morphologies. HypothesisWe aimed to determine whether computer-assisted acromioplasty planning helps surgeons remove impinging bone, reduce unnecessary resections, and improve short-term outcomes of rotator cuff tears (RCR). Patients and methodsWe randomized 64 patients undergoing RCR of full-thickness supraspinatus tears into two groups: ‘guided acromioplasty’ (GA) and ‘freehand acromioplasty’ (FA). The pre- and post-operative scapula models were reconstructed using computed-tomography scans to quantify impinging bone removal, unnecessary bone resections, and identify zones of acromial bone removal. All patients were evaluated preoperatively and at 6 months to assess their range of motion (ROM), functional scores and tendon integrity using ultrasound. ResultsThe two groups did not differ in demographics, clinical or morphologic characteristics. Compared to FA, GA tended to lower impinging bone removal (55±26% vs. 43±27%, p=0.087) and to increase unnecessary resection of the total bone removed (49±22% vs. 57±27%, p=0.248). GA resulted in significant anterior under-resection, while FA resulted in significant medial over-resection. Clinical outcomes and ROM improved significantly for all patients, except for internal rotation in the GA group. There were no other significant differences between the two groups, neither in terms of post-operative scores nor in terms of clinical net improvements, nor tendon repair integrity. ConclusionsThis computer-assisted planning for acromioplasty during RCR proved no benefits in terms of bone removal, tendon healing, or clinical outcomes. Nonetheless such planning tools could help less experienced surgeons improve the efficacy of acromioplasty. Level of proofI, Randomized controlled trial (Therapeutic study)

Minimally invasive cheilectomy

Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. Hallux rigidus gradesII andIII CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis. Osteophytes around the metatarsophalangeal joint are removed using a1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with aburr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with arangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy. Removal of the sutures after 2weeks. Depending on pain, the patient can change from the postoperative shoe to anormal soft, comfortable and wide shoe after1-2weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended. The technique allows asoft-tissue-preserving resection of the osteophytes and apartial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21women and 17men with hallux rigidus stagesII andIII (Vanore) underwent surgery. Minimum follow-up was 12months. In 1patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to ametatarsophalangeal fusion, while another patient received aresection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7points.

Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease: An Observational Study of a Historical Cohort.

Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group.We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton.We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR).All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80–10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16–19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality.The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality.

Image Merge Assisted Minimally Invasive Resection of Intradural Extramedullary Tumors: A Retrospective Series of Eight Cases

Introduction Intradural extramedullary spinal tumors are rare lesions, with a prevalence of 3 to 10 per 100,000 in general population. Open bilateral laminectomy with partial or total facet removal is the standard surgical access for gross total resection (GTR) of such tumors. Studies in patients operated with laminectomy, the risk of developing postoperative deformity, particularly in the cervical spine, is still significant, accounting of 20 to 60% of patients treated with laminectomy. In addition, ventrolateral or ventrally placed tumors are often not easily accessible through a standard translaminar approach. In the present series, preoperative MRI data and intraoperative three-dimensional (3D) fluoroscopic images are manually merged in the operating room. Minimally invasive surgical techniques through a tubular retractor system are then used to resect the tumor. The merged images are used to plan the ideal trajectory to the lesion, thus, facilitating tumor access while minimizing bone and soft tissue resection in these patients. Methods A retrospective chart review of 45 consecutive surgical cases of intradural tumors over a 7-year period was performed. Eight patients operated for intradural extramedullary tumors using the image merge technique. Preoperative MRI and intraoperative 3D fluoroscopic data were manually merged using Synergy Cranial 2.2 software and Stealth Merge 1.2. Accuracy of manual image merging was verified with anatomic landmarks as references. Using these merged images, a trajectory from skin to tumor is planned to facilitate microsurgical tumor resection. The trajectory chosen defines the skin incision, and the type and extent of bone resection. Following 3 to 4 cm skin incision, a transmuscular expandable retractor is “docked” onto the spine. Bone drilling is tailored to the tumor margins using the merged images. From this point on, standard microsurgical resection is performed, followed by dural closure. Results From December 2012 to September 2014, five male and three female patients underwent tubular resection of intradural extramedullary spine tumors with the image merge assistance. Preoperative Nurick score was 3 in three patients, 1 in two patients, and 0 in remaining three patients. Follow-up neurological Nurick scores recording reveal a favorable neurological outcome with a score of 0 in seven patients. Follow-up ranges from 2 to 14 months (average, 5.8 months). No patient showed postoperative neurological deterioration. Only one patient with a resected L1 Schwannoma complains of postoperative radicular pain, which is responsive to medical treatment. MRI confirmed GTR in all cases. Conclusion In this small series, image merge assisted minimally invasive resection of intradural extramedullary lesions achieves maximum tumor resection while minimizing spinal cord manipulation and tailoring bone resection to reduce the risk of postoperative instability. This appears to be a safe and feasible procedure for such lesions.

Quality of life in oral cancer patients – Effects of mandible resection and socio-cultural aspects

Introduction The aim of this study was to assess the postoperative quality of life in oral cancer patients depending on different mandible resection types and to collect information about their socio-cultural situation. Material and methods In this cross-sectional study, patients with primary oral cancer treated with different types of mandibular resection in the Clinic of Oral and Maxillofacial Surgery at the University of Kiel between 1997 and 2007 were included. Quality of life was assessed by means of the EORTC QLQ-C30 and H&N 35 questionnaires. Furthermore, a questionnaire about the socio-cultural background of the patients was applied. To be included, at least one year had to be passed after tumour resection. Results 111 of 235 questionnaires were returned (47%). Significant differences in quality of life were found between patients with soft tissue resections and bone resections. There were significant worse values for continuity resections compared to only partial resections. Sixty-seven patients (60.4%) had a graduation of an elementary school as the highest school graduation, four patients (3%) had no school graduation. Conclusions The postoperative quality of life in our patients was significantly influenced by the extent of bone resection. This should be considered for surgical planning. The socio-cultural data showed a rather low education level for the majority of the patients.

Tailored Surgical Approaches for Benign Craniovertebral Junction Tumors

We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Surgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. Human cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. The minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. These techniques may play a role in deformity surgery for select cases with further technological advancements.

The Prognostic Impact of Extent of Bone Invasion and Extent of Bone Resection in Oral Carcinoma

The prognostic impact of mandibular invasion by oral squamous cell carcinoma (SCC) is controversial. The objective of this study was to assess the effect that extent of bone invasion has on recurrence and survival in patients treated with marginal and segmental mandible resection. A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively into a dedicated head and neck database. Local control and disease-specific survival were retrospectively reviewed in 111 patients (median follow-up, 44 months) with oral SCC undergoing marginal or segmental mandibulectomy. Bone invasion was present in 46% of marginal and 94% of segmental resections. Five-year local control was similar following marginal (83%) and segmental mandibulectomy (86%). There was no correlation with presence or extent of bone invasion. Survival at 5 years was 71% and this correlated with bone invasion and involved margins (P < .05), but not with extent of mandible invasion or resection. Marginal mandibulectomy does not adversely alter outcome in selected patients with bone invasion provided margins are not compromised.

Management of benign craniovertebral junction tumors.

We report our surgical experience in the treatment of fifteen consecutive patients with benign craniovertebral junction tumors, observed from 1993 to 2000 at our department. We treated 7 meningiomas, 3 epidermoids, 3 C1 neurinomas and 2 neurinomas of the lower cranial nerves. Clinical results were evaluated by Karnofsky Performance Scale and all patients underwent preoperative neuroradiological evaluation with CT, MRI and MRA; angiography was not routinely performed and was considered for each individual case. 11 partial transcondilar and 4 retrocondilar approaches were performed. Total removal was achieved in 11 cases (73,3%) and subtotal removal in 4 patients (26,7%). None of the patients required occipitocervical fusion. Patients were followed for an average period of 24+/-31 months. Clinical and radiological follow-up showed no recurrence in cases with total removal. In all patients a statistically significant postoperative increase of KPS scores was recorded. The treatment of epidermoid tumors presented particular issues: debulking the lesion, we obtained a surgical window, avoiding a large removal of bone. In Nakasu grade 1 or 2 meningiomas, we carried out total removal by piecemeal resection and without complete condylectomy and bone fixation. The choice of these approaches and the extent of bone resection should be defined according to the tumor's location and size. Moreover we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in order to tailor the technique to different lesions, providing the required exposure, without unnecessary surgical steps.

Squamous Cell Carcinomas of the Mandibular Alveolus: Analysis of Prognostic Factors

Background: To assess the effect of clinicopathologic factors on local tumor control and survival in patients with mandibular alveolar carcinoma. Methods: Fifty patients with mandibular alveolar carcinoma treated surgically were included in this study. There were 3 patients with T1, 25 with T2, 5 with T3, and 17 with T4 disease. Clinical evidence of bone invasion was noted in 47 patients. A hemi- or segmental mandibulectomy was performed on 37 patients, whereas 10 patients had a marginal mandibulectomy. The impact of clinicopathologic variables on local tumor control and patient survival was assessed by univariate analysis. Variables included T and N stage, dental extraction, treatment modality, tumor differentiation, nodal status, surgical margin, and bone invasion. Results: Eleven patients (22%) develop recurrent disease, including 8 local recurrences, 1 neck, and 2 distant metastases. Overall, the 5-year actuarial rates of local control and disease-specific survival were 85 and 73%, respectively. Most local recurrences after surgical treatment were caused by inadequate resection margins. When resection margins were negative, the survival and local control rate were significantly better than when there were positive resection margins (survival, 91 vs. 11%; local control, 100 vs. 49%; p < 0.01). Neither T and N stages, clinical stage, tumor differentiation, dental extraction, bone invasion, extent of bone resection, nor treatment modality influenced outcome. Conclusions: The status of surgical margins was of major importance for the outcome of patients with gingival carcinoma of the mandible.

Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases

Background: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. Purpose: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. Material: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex róntgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. Methods: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. Results: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. Conclusion: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.

Prognostic implications of mandibular invasion in oral cancer.

Mandibular invasion alters the clinical staging and management of oral epidermoid carcinoma on the assumption that underresection of mandibular bone invaded by tumor can result in disease progression and poor outcome. Cox's proportional hazard model was used to assess the effect of mandibular invasion on recurrence-free survival in 107 patients with squamous cell carcinoma of the oral cavity after controlling for the potential confounding effect of positive margins, tumor size, nodal status, and type of resection. Mandibular invasion was characterized as none (n = 59), focal (n = 25), or deep (n = 23). Relapse-free survival at 60 months by the Kaplan Meier product limit method for the none, focal, and deep invasion groups was 61%, 73%, and 46% respectively (p =.28). Variables influencing disease recurrence were positive margins, size >2 cm, N2 and N3 nodal disease, and marginal vs segmental mandibular resection. Mandibular invasion was not a significant risk factor for disease recurrence with an adjusted hazard ratio for deep invasion vs focal or no invasion of 1.0 (95% CI = 0.5, 2.2; p = 1.00). Detection of bone invasion, particularly in small tumors, may not be as critical to surgical planning as previously expected. The necessity for and extent of bone resection should be determined by the objective of achieving an adequate surgical margin and not the presence of bone invasion per se.

Meningioma of the foramen magnum: A series of 40 cases

Surgical treatment of foramen magnum meningiomas (FM meningiomas) has been improved by the recently developed posterolateral and anterolateral approaches. The choice of these approaches and the extent of bone resection, however, need to be defined according to the tumor location. Over a short period (1980-1993), 40 cases of FM meningiomas were treated either by the posterolateral (N = 31), the anterolateral (N = 5), or the midline posterior approaches (N = 4). The choice of surgical technique (surgical approach, extent of bone drilling, and dural opening) was made according to the tumor location, which is defined by three parameters: the horizontal plane (anterior N = 18, lateral N = 21, and posterior N = 1); the vertebral artery (above N = 4, below N = 20, and on both sides N = 16); the dura mater (intradural N = 24, extradural N = 2, and intraextradural N = 4). Intradural anterior and lateral FM meningiomas were operated by the posterolateral approach. The bone drilling was limited either to the occipital condyle or to the lateral mass of the atlas, depending on whether the tumor location is above or below the vertebral artery, respectively. Intradural posterior meningiomas were treated by the midline posterior approach. FM meningiomas with an extradural component were resected by the anterolateral approach alone or combined with a midline posterior approach. The rate of complete resection was 94% for intradural FM meningiomas and 50% for the extradural ones. FM meningiomas with an extradural component generally have aggressive features invading the adjacent bone and soft tissues; this explains the difficulty of performing a complete resection. The clinical condition improved in 90%, worsened in 7.5%, and did not change in 2.5%. The worsened group consisted of three deaths (one case of air embolism, one case of pulmonary embolism, and one case with preoperative coma and tetraplegia). Similar results were obtained in both anterior and lateral locations. FM meningiomas can be completely and safely removed in most cases, using an appropriate surgical technique. The technique must be chosen after precise and correct analysis of the tumor location. The lateral approaches are very effective in the treatment of lateral and anterior FM meningiomas.

Simulation of Surgical Approaches to Cerebral Aneurysms Using Three

In four difficult aneurysms cases, preoperative views of surgical approach were obtained by three-dimensional and multiplanar reconstruction imaging methods using helical CT scanner. Simulation of various surgical approach views are also possible and an appropriate surgical approach is selected by comparing various surgical views. With this imaging technique, elimination of skull base bone, namely, simulation of bone drilling including the site and extent of bone resection is freely available. The diameter of the orifice of aneurysms and calcified portion of the wall are also visualized. One of the limitations is that small vessels less than 1 mm in diameter are not visualized.