Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI... COMMENTARY Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello’s Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video Paul A. Gardner, MD his case presents the resection of a very space into Dorello’s canal makes them more likely small, likely radiation-induced, menin- than meningiomas, which rarely cause cranial Cranial Base Surgery Center, Department gioma that caused an abducens palsy by nerve palsies without involving the cavernous of Neurological Surgery, University of compression at the entry to Dorello’s canal . sinus. Pittsburgh Medical Center, Pittsburgh, Pennsylvania This case has several unique aspects related This is a case where endoscopic assistance may to the diagnosis. The adjacent ectatic basilar provide significant value in confirming complete Correspondence: artery rendered even high-resolution magnetic resection by completely visualizing Dorello’s Paul A. Gardner, MD, resonance imaging incapable of identification canal and could be used throughout tumor Co-Director, Cranial Base Surgery Center, Department of Neurological Surgery, of the lesion preoperatively. It is not surprising resection. In addition, retractorless surgery has University of Pittsburgh Medical Center, that vascular compression was not the cause of appropriately gained increasing popularity and 200 Lothrop St, Ste B400, this patient’s abducens palsy. Rather, the most could be applied in this case. Nevertheless, Pittsburgh, PA 15213. E-mail: gardpa@upmc.edu common cause of an isolated abducens palsy is the patient’s outcome speaks for itself and was microvascular ischemia, especially in the setting achieved through careful, preoperative clinical Received, April 19, 2018. of diabetes . This can be a diagnosis of exclusion evaluation and microsurgical technique. Accepted, May 3, 2018. and pattern of presentation given its prevalence. However, as a result, exploration for isolated Disclosure Copyright 2018 by the abducens palsy is generally not recommended. Congress of Neurological Surgeons The author has no personal, financial, or institutional The key in this case is the progressive history interest in any of the drugs, materials, or devices described rather than the sudden onset generally seen with in this article. ischemia. The authors’ clinical acumen is to be commended in an era wherein we are increas- REFERENCES ingly dependent on imaging for diagnosis. As 1. Alturki A, Enriquez-Marulanda A, Gupta R, Thomas surgeons, it is critical that we remain focused on AJ, Ogilvy CS. Microsurgical resection of a meningioma clinical presentation and exam. at the entrance of Dorello’s canal causing VI cranial nerve compression: 2-Dimensional operative video. Oper Neurosurg. In addition, bony tumors such as chordoma 17 April 2018. doi:10.1093/ons/opy082 [published online or chondrosarcoma, though rare, are generally ahead of print]. associated with abducens palsy. Their pre- 2. Kung NH, Van Stavern GP. Isolated ocular motor nerve palsies. Semin Neurol. 2015;35(5):539-548. dilection for extension through the interdural OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy140/5025505 by Ed 'DeepDyve' Gillespie user on 12 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

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Publisher
Congress of Neurological Surgeons
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy140
Publisher site
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Abstract

COMMENTARY Commentary: Microsurgical Resection of a Meningioma at the Entrance of Dorello’s Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video Paul A. Gardner, MD his case presents the resection of a very space into Dorello’s canal makes them more likely small, likely radiation-induced, menin- than meningiomas, which rarely cause cranial Cranial Base Surgery Center, Department gioma that caused an abducens palsy by nerve palsies without involving the cavernous of Neurological Surgery, University of compression at the entry to Dorello’s canal . sinus. Pittsburgh Medical Center, Pittsburgh, Pennsylvania This case has several unique aspects related This is a case where endoscopic assistance may to the diagnosis. The adjacent ectatic basilar provide significant value in confirming complete Correspondence: artery rendered even high-resolution magnetic resection by completely visualizing Dorello’s Paul A. Gardner, MD, resonance imaging incapable of identification canal and could be used throughout tumor Co-Director, Cranial Base Surgery Center, Department of Neurological Surgery, of the lesion preoperatively. It is not surprising resection. In addition, retractorless surgery has University of Pittsburgh Medical Center, that vascular compression was not the cause of appropriately gained increasing popularity and 200 Lothrop St, Ste B400, this patient’s abducens palsy. Rather, the most could be applied in this case. Nevertheless, Pittsburgh, PA 15213. E-mail: gardpa@upmc.edu common cause of an isolated abducens palsy is the patient’s outcome speaks for itself and was microvascular ischemia, especially in the setting achieved through careful, preoperative clinical Received, April 19, 2018. of diabetes . This can be a diagnosis of exclusion evaluation and microsurgical technique. Accepted, May 3, 2018. and pattern of presentation given its prevalence. However, as a result, exploration for isolated Disclosure Copyright 2018 by the abducens palsy is generally not recommended. Congress of Neurological Surgeons The author has no personal, financial, or institutional The key in this case is the progressive history interest in any of the drugs, materials, or devices described rather than the sudden onset generally seen with in this article. ischemia. The authors’ clinical acumen is to be commended in an era wherein we are increas- REFERENCES ingly dependent on imaging for diagnosis. As 1. Alturki A, Enriquez-Marulanda A, Gupta R, Thomas surgeons, it is critical that we remain focused on AJ, Ogilvy CS. Microsurgical resection of a meningioma clinical presentation and exam. at the entrance of Dorello’s canal causing VI cranial nerve compression: 2-Dimensional operative video. Oper Neurosurg. In addition, bony tumors such as chordoma 17 April 2018. doi:10.1093/ons/opy082 [published online or chondrosarcoma, though rare, are generally ahead of print]. associated with abducens palsy. Their pre- 2. Kung NH, Van Stavern GP. Isolated ocular motor nerve palsies. Semin Neurol. 2015;35(5):539-548. dilection for extension through the interdural OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy140/5025505 by Ed 'DeepDyve' Gillespie user on 12 July 2018

Journal

Operative NeurosurgeryOxford University Press

Published: May 30, 2018

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