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: firstname.lastname@example.org 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
Operative Neurosurgery – Oxford University Press
Published: May 30, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera