Meningioma of Lower Clivus Surrounding Vertebral Artery
Extreme Lateral/Transcondylar Meningioma of Lower Clivus Surrounding Vertebral Artery
Fig.1 Sagittal MRI shows meningioma behind the lower clivus and atlas pressing the brain stem.
Fig.2 Coronal MRI shows the left vertebral artery going through the tumour.
Fig.3 In far lateral approach, retrosigmoid craniectomy extended inferiorly upto foramen magnum, Vertebral artery is rerouted posteriorly after opening foramen transversorium in atlas. One third of occipital condyle can be resected.
Fig.4 Levator scapulae (LS) & splenius capitus (SC) muscles were detached and retracted posteriorly. This exposes superior & inferior oblique muscles (SO & IO) attached to C1 transverse process (C1). MT – mastoid tip. Yellow arrow – XI cranial nerve.
Fig.5 Oblique muscles were removed. Tip of C1 transverse process is removed to open foramen transversorium (two white lines). Yellow arrows points at the the vertebral artery surrounded by venous plexus. Green arrow – posterior arch of atlas.
Fig.6 Posteriorly rerouted vertebral artery (yellow arrows) from C2 to the dural entry point. OC – occipital condyle. Green arrow – foramen magnum.
Fig.7 Retrosigmoid occipital craniectomy exposes the dura. Yellow arrows – vertebral artery. OC – partially removed occipital condyle. Green arrow – Dura at the level of foramen magnum. Red arrow – site of vertebral artery entry point posterior to OC.
Fig.8 Post-op MRI shows complete resection of tumour.
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)