Circular multiple burr hole for surgical removal of an extra and intracranial meningioma (technical note)

N. Haiat, M. Pereira, D. Gonsalves, P. H. Pires Aguiar, B. M. Lopes, I. Estevão, C. C. Pacheco, P. Aguiar
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Abstract

Introduction. Intracranial meningiomas are the most common primary central nervous system tumors and are mostly benign, arising from the meninges surrounding the brain, nerves, and vessels. An obstacle to the surgical resection of meningiomas is the risk of injury to the superior sagittal sinus and the resulting compromise to the integrity of the venous drainage. This article describes a circular multiple trepanation technique, which can be used to safely perform resection of extracranial and intracranial meningiomas, aiming to reach the largest possible tumor area, since patient prognosis is directly proportional to tumor resection.Surgical technique. The first step is to make a horseshoe incision, then drill burr holes, forming a circumference around the bone meningioma. The next step is to connect the orifices, incising the dura mater affected by the tumor along the periphery of the extracranial meningioma. Subsequently, the bone and the dura mater are elevated. Thus, the bone and dural part are separated from the intradural part, which is, in turn, removed later. Results. The circular multiple trepanation technique was performed and a gross total resection of the extracranial and intracranial meningioma (Simpson grade I) was achieved. The postoperative period showed positive results, with an improvement in the patient’s eye disorder and interruption of generalized tonic‑clonic seizures.Conclusion. The circular multiple trepanation approach for treating extracranial and intracranial meningiomas described in this note is performed safely and effectively, with good patient prognosis. Although it is a recognized option, it has been insufficiently described, and it is therefore important to expand the knowledge and proper use of this technique among neurosurgeons.
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圆形多钻孔手术切除颅内外脑膜瘤(技术说明)
介绍。颅内脑膜瘤是最常见的原发性中枢神经系统肿瘤,大多为良性,起源于脑、神经和血管周围的脑膜。手术切除脑膜瘤的一个障碍是有损伤上矢状窦的风险,并因此损害静脉引流的完整性。本文介绍了一种环形多重钻孔技术,该技术可以安全地切除颅外和颅内脑膜瘤,目的是尽可能达到最大的肿瘤面积,因为患者的预后与肿瘤的切除成正比。手术技术。第一步是做一个马蹄形切口,然后钻孔,在骨脑膜瘤周围形成一个圆周。下一步是连接孔,沿着颅外脑膜瘤的外围切开受肿瘤影响的硬脑膜。随后,骨和硬脑膜被抬高。因此,骨和硬脑膜部分与硬脑膜内部分分离,硬脑膜内部分随后被移除。结果。行环形多重钻孔术,行颅外及颅内脑膜瘤(Simpson I级)全切除术。术后表现良好,患者眼疾得到改善,全身性强直性阵挛发作中断。环形多次钻孔入路治疗颅外和颅内脑膜瘤安全有效,患者预后良好。虽然这是一种公认的选择,但它的描述还不够充分,因此在神经外科医生中扩大这一技术的知识和正确使用是很重要的。
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