Removal of the Involved Bone and Dura

Following complete tumor removal, the site of tumor origin is carefully inspected. If possible, the involved dura and bone are removed. In tumors of basal locations, the involved bone is drilled using a small diamond burr, which is also quite effective in achieving hemostasis from tumor feeders arising directly from the base of the skull. Involved bone adjacent to paranasal sinuses is aggressively drilled, short of entering the sinus space. Inadvertent opening into paranasal sinuses or mastoid air cells must be recognized and appropriately sealed with muscle/fat graft or bone wax.

In 1983, Dolenc introduced an extensive extradural skull base technique to gain safe entry into the cavernous sinus. The critical steps of this technique, following a routine frontotemporal craniotomy and drilling of the lateral sphenoid wing, include complete bone removal around the superior orbital fissure (SOF), posterior orbitotomy, optic canal unroofing, extradural removal of the ACP, and removal of bone around the foramen rotundum and ovale. Meningiomas of the posterior orbital roof, cavernous sinus (CS), sphenoid wing or orbitosphenoid regions frequently cause hyper-ostosis of the orbital roof, and the greater and lesser sphenoid wing, including the ACP. For these tumors, the Dolenc approach, with modifications tailored to removal of only the involved bone, is an ideal technique.

In addition, the extensive sphenoid bone removal of the Dolenc approach, when coupled with the extradural exposure of the CS, facilitates removal of the involved dura, especially the portion of temporal dura covering the medial greater sphenoid wing, which simultaneously forms the outer lateral wall of CS. Following extradural bone removal as summarized above, the dural fold at the superolateral aspect of the SOF is sharply cut with microscis-sors tangential to the temporal dura. The temporal dura forming the outer lateral CS wall is then "peeled" off the underlying inner CS lateral wall. This process of separating the two-layered CS lateral wall is continued laterally and posteriorly until all three divisions of the trigeminal

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