SURGICAL VIDEO Resection of Large Petrotentorial Tumor via a Retrosigmoid Approach: 3-Dimensional Operative Video William T. Couldwell, MD, PhD Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy144 Correspondence: William T. Couldwell, MD, PhD, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N Medical Drive East, Salt Lake City, UT 84132. E-mail: email@example.com wasintimatelyinvolvedwiththe tumorasthe tumor A 22-yr-old female college athlete had noted ataxia during was emanating from the tentorial edge where the competitive gymnastic events. Magnetic resonance imaging revealed a large tumor compatible with preop- fourth nerve entered. In most instances, the nerves erative diagnosis of meningioma arising from the petro- are displaced by the tumor but in this case injury to tentorial region with marked brainstem compression. the fourth nerve ensued with dissection at the tumor The technical challenges associated with this removal attachment. After tumor resection, the interrupted fourth include safe dissection of cranial nerves IV to VIII and nerve was repaired microsurgically. A hemangioperi- dissection from the brainstem and cerebellum, taking cytoma was identified on pathological analysis, and the care to not interfere with blood supply to these struc- patient received postoperative radiation therapy, which tures. The vascular tumor was removed via standard hasbeen givenpostoperativelyor at recurrenceinthe suboccipital approach, with the trajectory above the literature. Technical nuances of removal are discussed. seventh/eighth nerve complex. The attachment was Patient consent was granted for publication of this at the petrotentorial junction, and the fourth nerve video. KEY WORDS: Hemangiopericytoma, Petrotentorial, Ataxia, Retrosigmoid approach, Skull base Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy144 Received, August 24, 2017. Accepted, May 8, 2018. Disclosure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy144/5003029 by Ed 'DeepDyve' Gillespie user on 12 July 2018
Operative Neurosurgery – Oxford University Press
Published: May 24, 2018
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