Meningiomas

Fig. 12.7. a Following completion of the extradural skull base technique described in Figures 12.4 and 12.5, the process that allows for removal of the sphenoid bone involved by the tumor; the temporal dura forming the outer portion of the two-layered CS wall is "peeled off" the inner CS wall. This is best started by sharply and tangentially cutting the dural fold at the superiolateral aspect of the completely exposed SOF. bThis "peeling" process is continued posteriorly and laterally until all three divisions of the trigeminal nerve and the gasserian ganglion are exposed. In this manner, the lateral aspect of the CS is exposed entirely extradurally, freeing up the anterior and medial temporal dura, commonly involved by CS or sphenoid wing/orbitosphenoid meningiomas, for aggressive removal along with the rest of the tumor. GG, gasserian ganglion; R, right.

Fig. 12.7. a Following completion of the extradural skull base technique described in Figures 12.4 and 12.5, the process that allows for removal of the sphenoid bone involved by the tumor; the temporal dura forming the outer portion of the two-layered CS wall is "peeled off" the inner CS wall. This is best started by sharply and tangentially cutting the dural fold at the superiolateral aspect of the completely exposed SOF. bThis "peeling" process is continued posteriorly and laterally until all three divisions of the trigeminal nerve and the gasserian ganglion are exposed. In this manner, the lateral aspect of the CS is exposed entirely extradurally, freeing up the anterior and medial temporal dura, commonly involved by CS or sphenoid wing/orbitosphenoid meningiomas, for aggressive removal along with the rest of the tumor. GG, gasserian ganglion; R, right.

was achieved. Following a subtotal removal, subsequent follow-up with MRI is done every year, with plans of adjuvant radiation if and when there is clinical or radiographic progression of the residual tumor. If the tumor is noted to be clinically and radiographically stable for a few years after initial surgery, the frequency of follow-up may be decreased to every 2-3 years. For atypical meningiomas, after initial post-operative MRI following either subtotal or total removal, subsequent evaluations with MRI are performed every 6 months for the first 2 years. As with benign tumors, radiation is considered in the presence of documented clinical or radiographic progression of the residual tumor. With malignant meningiomas, adjuvant radiation is administered shortly after surgery regardless of the extent of resection. However, if there is any reversible post-operative neurological deficit from brain swelling or cranial nerve manipulation, the timing of radiation therapy should be delayed to allow for adequate recovery. Depending on the extent of resection, follow-up MRI scans are performed every 3-6 months.

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