Treatment of craniovertebral junction meningioma is a difficult task. Surgical treatment is the gold standard for these patients. However, it is associated with high risk of neurological impairment, while combined treatment (surgery + radiotherapy) provides more favorable outcomes.
To present the results of surgical and combined treatment of patients with craniovertebral junction meningioma.
There were 196 patients with craniovertebral junction meningioma who underwent surgical or combined (surgery + radiotherapy) treatment at the Burdenko Neurosurgery Center between January 2005 and June 2022. The sample included 151 women and 45 men (3.4:1). Resection of tumor was performed in 97.4% of patients, craniovertebral junction decompression with dural defect closure - 2%, ventriculoperitoneostomy - 0.5%. As the second stage, 40 patients (20.4%) underwent radiotherapy.
Total resection was achieved in 106 patients (55.2%), subtotal - 63 (32.8%), partial - 20 (10.4%), tumor biopsy was performed in 3 (1.6%) cases. Intraoperative complications occurred in 8 patients (4%), postoperative complications - in 19 (9.7%) cases. Radiosurgery was carried out in 6 (15%) patients, hypofractionated irradiation - 15 (37.5%), standard fractionation - 19 (47.5%) patients. Tumor growth control after combined treatment made up 84%.
Clinical outcomes in patients with craniovertebral junction meningioma depend on tumor dimensions, topographic and anatomical localization of tumor, resection quality and relationship with surrounding structures. Combined treatment of anterior and anterolateral meningiomas of the craniovertebral junction is preferable compared to total resection.
Лечение менингиом области краниовертебрального перехода (МОКВП) представляет собой трудную задачу. Хирургическое лечение является «золотым стандартом» при МОКВП, однако оно сопряжено с высоким риском развития неврологического дефицита, в то время как комбинированное лечение (хирургическое+лучевое) имеет более благоприятные исходы.
Сопоставить результаты хирургического и комбинированного лечения пациентов с МОКВП и выявить предикторы клинических исходов.
В период с января 2005 по июнь 2022 г. зафиксировано 196 больных, которые получали хирургическое или комбинированное (хирургическое+лучевое) лечение в ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава России; среди них — 151 женщина и 45 мужчин, соотношение по полу — 3,4:1. В 97,4% случаев проведено удаление опухоли, в 2% — декомпрессия краниовертебрального перехода с пластикой твердой мозговой оболочки, в 0,5% — вентрикулоперитонеостомия. В качестве второго этапа лечения 40 (20,4%) пациентов прошли курс лучевой терапии.
Тотальное удаление опухоли было достигнуто у 106 (55,2%) пациентов, субтотальное — у 63 (32,8%), частичное — у 20 (10,4%); открытая биопсия опухоли выполнена у 3 (1,6%) больных. Интраоперационные осложнения развились у 8 пациентов (4%), послеоперационные осложнения — у 19 (9,7%). По режиму лучевого лечения распределение было следующим: радиохирургия — 6 (15%) человек, гипофракционирование — 15 (37,5%), стандартное фракционирование — 19 (47,5%). Контроль опухолевого роста в группе комбинированного лечения достигнут у 84% пациентов.
Клинические исходы у больных МОКВП зависят от размеров опухоли, ее топографо-анатомического расположения, радикальности удаления и взаимосвязи с окружающими структурами. Применение комбинированного подхода к лечению МОКВП переднего и переднелатерального расположения является предпочтительным видом лечения в сравнении с радикальным удалением опухоли.

UNASSIGNED: Cavernous sinus (CS) invasion is frequently encountered in the management of skull base tumors. Surgical treatment of tumors in the CS is technically demanding, and selection of an optimal surgical approach is critical for maximal tumor removal and patient safety. We aimed to evaluate the feasibility of an endoscopic transorbital approach (ETOA) to the CS based on a cadaveric study.
UNASSIGNED: Five cadaveric heads were used for dissection under the ETOA in the comparison with the endoscopic endonasal approach (EEA) and the microscopic transcranial approach (TCA). The CS was exposed, accessed, and explored, first using the ETOA, followed by the EEA and TCA. A dedicated endoscopic system aided by neuronavigation guidance was used for the procedures. During the ETOA, neurovascular structures inside the CS were approached through different surgical triangles.
UNASSIGNED: After completing the ETOA with interdural dissection, the lateral wall of the CS was fully exposed. The lateral and posterior compartments of the CS, of which accessibility is greatly limited under the EEA, were effectively approached and explored under the ETOA. The anteromedial triangle was the largest window via which most of the lateral compartment was freely approached. The internal carotid artery and abducens nerve were also observed through the anteromedial triangle and just behind V1. During the ETOA, the approaching view through the supratrochlear and infratrochlear triangles was more directed towards the posterior compartment. After validation of the feasibility and safety based on the cadaveric study, ETOA was successfully performed in a patient with a pituitary adenoma with extensive CS invasion.
UNASSIGNED: Based on the cadaveric study, we demonstrated that the lateral CS wall was reliably accessed under the ETOA. The lateral and posterior compartments of the CS were effectively explored via surgical triangles under the ETOA. ETOA provides a unique and valuable surgical route to the CS with a promising synergy when used with EEA and TCA. Our experience with a clinical case convinces us of the efficacy of the ETOA during surgical management of skull base tumors with CS-invasion.

UNASSIGNED: To analyze the surgical effects of resecting skull base tumors using multimodal three-dimensional (3D) image fusion technology in the neurosurgery department and present some typical cases.
UNASSIGNED: From October 2019 to October 2021, we included 47 consecutive patients with skull base tumors in the Neurosurgery Department at Zhuhai People\'s Hospital in this study. Pre-operative head computed tomography and magnetic resonance imaging data acquisition was performed using the GE AW workstation software for registration fusion, image fusion, and 3D reconstruction. The surgical approach and surgical plan were designed based on the multimodal 3D image, and the resection rate, complication rate, and operative time of the surgery using the multimodal image fusion technique were analyzed.
UNASSIGNED: The reconstructed multimodal 3D images precisely demonstrated the size, location, and shape of the tumor along with the anatomical relationship between the tumor and surrounding structures, which is consistent with the intraoperative findings. Among 47 patients, 39 patients (78.7%) underwent total resection, 5 (14.9%) underwent subtotal resection, and 3 (6.4%) underwent partial resection. The mean operative time was 4.42 ± 1.32 h. No patient died during the inpatient period. Post-operative complications included 6 cases of cerebrospinal fluid leakage (14.9%), 3 cases of intracranial infection (6.4%), 6 cases of facial paralysis (12.8%), 2 cases of dysphagia (4.3%), and 1 case of diplopia (2.1%), all of which were improved after symptomatic treatment. The application value of pre-operative 3D image fusion technology was evaluated as outstanding in 40 cases (85.1%) and valuable in 7 cases (14.9%).
UNASSIGNED: Pre-operative multimodal image fusion technology can provide valuable visual information in skull base tumor surgery and help neurosurgeons design the surgical incision, choose a more rational surgical approach, and precisely resect the tumor. The multimodal image fusion technique should be strongly recommended for skull base tumor surgery.

The anterior skull base structures are the site of initial growth of histologically different tumors. The difficulties in their removal are often associated with significant vascularization, which may limit the amount of resection due to abundant intraoperative blood loss. Midline tumors are primarily fed by the ethmoid arteries that are not accessible to embolization. The aim of this work was a comparative experimental study of various direct approaches to the ethmoid arteries.
METHODS: The study was conducted on anatomical specimens of 12 cadaveric heads of deceased people without pathology of the anterior skull base structures, orbits, nasal cavity, and paranasal sinuses (24 sides). In all specimens, the internal and external carotid arteries were stained with silicone. During anatomical dissection, four surgical approaches for exclusion of the ethmoid arteries were studied: 1) transorbital approach to the arteries using a bicoronal incision; 2) endoscopic retro-caruncular approach; 3) endoscopic endonasal transethmoidal approach to the ethmoid artery canals; 4) endoscopic endonasal transethmoidal transorbital approach to the ethmoid arteries in the orbit.
RESULTS: We described a surgical technique for exclusion of the ethmoid arteries using the approaches and analyzed their advantages and disadvantages. We formulated an algorithm for choosing the method for direct endoscopic exclusion of the ethmoid arteries, depending on the surgical approach chosen for removal of the tumor and features of the tumor extracranial spread.
CONCLUSIONS: The decision on tumor devascularization is based on assessment of tumor blood supply (CT angiography or MR angiography data). Our study demonstrated the advantages and disadvantages of various approaches to the ethmoid arteries for their exclusion in order to early devascularize anterior skull base tumors. All these approaches are less traumatic and characterized by a good cosmetic and functional outcome.
Передние отделы основания черепа являются местом исходного роста опухолей различной гистологической природы. Трудности их удаления нередко связаны со значительной васкуляризацией, что может ограничивать объем резекции из-за обильной интраоперационной кровопотери. Срединные опухоли получают кровоснабжение прежде всего из решетчатых артерий, которые недоступны для эмболизации. Цель исследования - сравнительное экспериментальное изучение различных вариантов прямого доступа к решетчатым артериям. Материал и методы. Исследование проведено на анатомических препаратах головы 12 тел умерших людей без патологии передних отделов основания черепа, глазниц, полости носа и околоносовых пазух (24 стороны). На всех препаратах было выполнено окрашивание внутренних и наружных сонных артерий силиконом. В ходе анатомической диссекции были изучены четыре варианта хирургического доступа для выключения решетчатых артерий: 1) эндоскопический эндоназальный трансэтмоидальный доступ к каналам решетчатых артерий; 2) эндоскопический эндоназальный трансэтмоидальный-трансорбитальный доступ к решетчатым артериям в глазнице; 3) ретрокарункулярный доступ к решетчатым артериям; 4) трансорбитальный доступ к решетчатым артериям с использованием бикоронарного разреза. Результаты. Описана хирургическая техника выключения решетчатых артерий с использованием указанных доступов, выявлены их преимущества и недостатки. Сформулирован алгоритм выбора способа прямого эндоскопического выключения решетчатых артерий в зависимости от выбранного хирургического доступа для удаления новообразования и особенностей его экстракраниального распространения. Заключение. Решение о необходимости деваскуляризации опухоли базируется на исследовании степени ее кровоснабжения (данных СКТ-ангиографии или МР-ангиографии). Наша работа продемонстрировала преимущества и недостатки различных доступов к решетчатым артериям для их выключения с целью ранней деваскуляризации новообразований передних отделов основания черепа. Все они малотравматичны и характеризуются хорошим косметическим и функциональным исходом.

OBJECTIVE: For recurrent malignant tumors occurring in the infratemporal fossa, it is difficult to select a proper surgical approach. We explore the efficiency of a new approach for removal of recurrent malignant tumors involving the infratemporal fossa based on the measurement on three-dimension CT, observation of six cadaveric specimens, and our surgical experience.
METHODS: The distances between the surgical landmarks in the infratemporal fossa were measured using CT data to determine the safe distance. And anatomy observation was examined on 6 formalin-fixed cadaveric specimens. Data from seven patients with recurrent malignant infratemporal fossa tumors were retrospectively analyzed.
RESULTS: The mean distance of the medial pterygoid plate from the zygoma was 52.12 mm. The maxillary artery can be found between the deep surface of the condyle and the sphenomandibular ligament, with mean distance of 8.25 ± 3.22 mm to the inferior border of the capsule of the temporomandibular joint. All tumors got gross resection using the maxillary-fronto-temporal approach with minor complication.
CONCLUSIONS: The advantages of the new approach include adequate protection of facial nerve with extended operation field; the exposed temporal muscle could be used to fill the dead space. This technique is especially useful to remove recurrent malignant infratemporal tumors safely.