Shyam Sundar Krishnan1, Pulak Nigam2, Veeraraghavalu Sudhakar Sathish Anand2, Madabushi Chakravarthy Vasudevan2. 1. Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India. Electronic address: shyamsundarkrishnan76@gmail.com. 2. Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India.
Abstract
BACKGROUND: Trigonal meningiomas have unique clinical presentation, unlike those in other areas of brain. Situated deep in the brain, the surgical nuances of this tumour are distinctive. We present our experience with this tumour including a discussion of surgical corridors that may be employed. METHODS: At our centre, 12 trigonal meningiomas were operated over past two decades. A retrospective analysis of case records of these cases was undertaken as regards age, sex clinical presentation, imaging and surgical approach. RESULTS: Mean time from heralding symptom to presentation was 10.4 months. At presentation, the most commonly encountered symptoms were those of non-localising symptoms attributable to raised ICP. Majority of lesions were more than 6 cm and on left side and the preferred surgical approach was inferior temporo-parietal. Most symptoms were relieved on long-term follow-up except homonymous hemianopia. CONCLUSION: The incidence of deficit is low on employing the "shortest route" approach, even in the dominant hemisphere and through eloquent area. This may be secondary to possible shift of eloquent area function due to longstanding lesion and may thus be a "workable" surgical option, especially in resource-limited centres where such resources as neuronavigation and tractography may be unavailable.
BACKGROUND:Trigonal meningiomas have unique clinical presentation, unlike those in other areas of brain. Situated deep in the brain, the surgical nuances of this tumour are distinctive. We present our experience with this tumour including a discussion of surgical corridors that may be employed. METHODS: At our centre, 12 trigonal meningiomas were operated over past two decades. A retrospective analysis of case records of these cases was undertaken as regards age, sex clinical presentation, imaging and surgical approach. RESULTS: Mean time from heralding symptom to presentation was 10.4 months. At presentation, the most commonly encountered symptoms were those of non-localising symptoms attributable to raised ICP. Majority of lesions were more than 6 cm and on left side and the preferred surgical approach was inferior temporo-parietal. Most symptoms were relieved on long-term follow-up except homonymous hemianopia. CONCLUSION: The incidence of deficit is low on employing the "shortest route" approach, even in the dominant hemisphere and through eloquent area. This may be secondary to possible shift of eloquent area function due to longstanding lesion and may thus be a "workable" surgical option, especially in resource-limited centres where such resources as neuronavigation and tractography may be unavailable.
Authors: Christoph Schwartz; Behnam Rezai Jahromi; Kimmo Lönnrot; Ahmad Hafez; Hidetsugu Maekawa; Martin Lehecka; Mika Niemelä Journal: Acta Neurochir (Wien) Date: 2020-08-09 Impact factor: 2.216