Full endoscopic endonasal transclival approach: Meningioma attached to the ventral surface of the brainstem

Autores de IIS La Fe

• Juan Antonio Simal Julian

  Autor

• Pablo Sanromán Álvarez

  Autor

• Pablo Miranda Lloret

  Autor

• Maria Estela Plaza Ramírez

  Autor

• Pedro Perez Borreda

  Autor

• Carlos Botella Asuncion

  Autor

Grupos

• Investigación Clínica y Traslacional en Cáncer

Abstract

Background: Intracranial meningiomas without dural attachment (MWODA) are rare entities. We present the first case published, to the best of our knowledge, regarding a MWODA attached to the ventral surface of the brainstem. This location makes the patient subsidiary to treatment through an expanded endonasal transclival approach. Clinical presentation: A 16-year-old female with suspected diagnosis of recurrence of a clear cell meningioma (CCM) at a distance from the initial lesion, located on the premedullary cistern. The patient underwent a pure endoscopic low transclival approach. The attachment to the ventral surface of the brainstem was confirmed intraoperatively. Postoperative MRI confirmed gross total resection and treatment was complemented with adjuvant fractionated stereotactic radiotherapy. No complications related to the procedure were observed. Conclusion: MWODA may appear attached to the ventral brainstem. The expanded endonasal approach to the clivus provides a critical anatomical advantage in the treatment of medial lesions, even ventral meningiomas, to the lower cranial nerves. Reconstruction principles must be strictly respected to reduce complications. (C) 2013 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L. All rights reserved.

Keywords

• Transclival approach; Dural attachment; Endonasal; Endoscope; Meningioma