Al-Mefty’s Meningiomas: Medicine & Health Science Books @ Al-Mefty’s Meningiomas Second Edition. Franco DeMonte, MD, FRCSC, FACS Professor of Neurosurgery and Head and Neck Surgery Mary. Al-Mefty O(1). Author information: (1)Department of Neurosurgery, University of Mississippi Medical Center, Jackson. Anterior clinoidal meningiomas are.
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This group of tumors is frequently reported to extend into the optic canal. These chapters, while focused on surgery, are extremely well illustrated with anatomic drawings, MR and CT, and angiography. Only three patients had total removal. Arterial Dissection Once the tumor is debulked, the distal branches of the middle cerebral artery are identified under high magnification and, using microdissection, the tumor capsule is removed from the arterial wall. In contrast, despite total encasement of arteries and nerves, total removal was possible in Group II, with meffy morbidity.
Both are well written and up to date, although there is little discussion of MRS or diffusion imaging in diagnosis and grading of meningioma.
Meningiomas[Title] – NLM Catalog Result
More recently, this was accomplished by exposing the intrapetrous segment of the carotid meningiokas. If the meningioma’s origin is proximal to the end of the carotid cistern Group Ias is the case with a meningioma originating from the inferior aspect of the anterior clinoid, the tumor will enwrap the carotid artery, directly adhering to the adventitia in the absence of an intervening arachnoid membrane Figs.
Dissection continues on the proximal carotid artery and into the cavernous sinus. The optic chiasm and the optic nerves in both Group I and II tumors are wrapped in the arachnoid membrane of the chiasmatic cistern, mwfty dissecting them free from the tumor is relatively easy with a microsurgical technique.
We excluded from the study meningiomas with origins as described intraoperatively on the tuberculum sellae, diaphragma sellae, planum sphenoidale, and middle and lateral sphenoid ridge, as well mefyt hyperostosing en plaque meningiomas.
Visual loss preceded diagnosis by 2 to 44 months average 25 months ; headache preceded surgery by an average of 68 months.
Opening the dura under the microscope provides a transitional adjustment of the surgeon’s dexterity from bone work to fine microsurgical dissection.
Recent advances in skull-base exposure, anesthesia, cerebral protection, microsurgical techniques, imaging, and surgery of the cavernous sinus have assisted in overcoming many of the formidable tasks in dissecting and preserving the vital neural and vascular structures involved with these tumors.
Scan obtained after total removal of the tumor including intracavernous and optic canal extensions.
For anyone interested in studying this specific neoplasm in depth,this book is worthwhile. Subtotal Removal The surgical mortality rate associated with anterior clinoidal meningiomas has remained unacceptably high. Acknowledging that the best chance for cure comes through radical total meningiomae, most authors, both pioneer and modern, have been content with subtotal removal to avoid the devastating sequelae of injury to the encased cerebral vessels; 6, 9, 17, 22, 31, 43, 51, 56 hence, repeated surgery and radiation therapy are frequently required.
As the carotid artery emerges from the cavernous sinus inferomedial to the menijgiomas clinoid, it enters the subdural space to be vested in the carotid cistern.
Al-Mefty’s Meningiomas – Google Books
New to this edition: The microsurgical technique has clearly improved the incidence of operative mortality and morbidity and the chance of total removal. A Group III meningioma. The dura is then closed in a watertight fashion, the jeningiomas bone flap positioned in place, and the skin closed in two layers.
The carotid, middle cerebral, and anterior cerebral arteries, as well as the optic apparatus, were all intimately involved with the tumor, being displaced, adherent, or totally engulfed.
The Role of Radiation Therapy The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in which subtotal removal or recurrence are prominent features. Radiographic Findings Computerized tomography CT scans in all cases revealed the presence of tumor and its extensions.
Al; mefty meningioma is an excellent book on meningioma which i have ever seen in my life. Preservation of the superficial temporal artery is important since the artery may be needed for extracranial-intracranial EC-IC anastomosis. Tumor removal around this area is continued using only microsurgical dissection with bipolar coagulation and careful piecemeal removal by microdissection. Cavernous Sinus Involvement When the tumor extends into the cavernous sinus, as it did in nine of our cases, proximal and distal control of the carotid artery is necessary.
Dissection of the Pituitary Stalk The pituitary stalk is easily recognized by its distinctive color and vascular network.
Discussion Distinguishing Clinoidal Meningiomas To subclassify anterior clinoidal meningiomas into three groups may be surprising since many authors find it difficult to distinguish clinoidal meningiomas from those with more lateral attachment on the sphenoid ridge, and prefer the notion of wide or small attachment.
ThiemeMay 17, – Medical – pages. The book is extensively illustrated with high quality figures—over —including anatomic drawings, operative photographs, and contemporary radiologic images with MR and CT. Sneed and Igor J. The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in which subtotal removal or recurrence are prominent features. Preoperative visual impairment improved in only two patients.
The anatomic drawings are just gorgeous and worthy of review by Neuroradiologists. In conclusion, this is a solid, up to date, and thorough review of the most meftg primary tumor of the central nervous system. Cushing’s series is a typical example: Of the 24 patients studied, 14 have been described in previous publications.
An analysis of these meningoomas leads to recognition of clinoidal meningiomas as a separate entity with distinguishing clinical, radiological, and surgical considerations.
However, unless total removal is achieved, detrimental regrowth is expected in the majority of patients. Retouched operative photograph showing the optic nerve IIthe anterior cerebral artery A 1the middle cerebral artery M 1and part of the internal carotid artery C dissected free from the encasing tumor T.
Twenty-four cases qualifying as clinoidal meningiomas were operated on over a 7-year period, from November,through October, The optic nerve maintains an arachnoid plane from the chiasmatic cistern. In patients having undergone previous surgery, the arachnoid membrane may be violated; subsequently, the dissection plane is lost and the tumor will be in direct contact with the adventitia.
There was one death 9 days postoperatively, due to pulmonary embolism, in a patient who was in excellent condition and was ready to be discharged. One patient had permanent third cranial nerve palsy.