Search Results

You are looking at 1 - 10 of 43 items for

  • Author or Editor: Marcos Tatagiba x
Clear All Modify Search
Restricted access

Madjid Samii, Marcos Tatagiba and Gustavo A. Carvalho

Object. The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).

Methods. The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.

Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.

Conclusions. Theapproach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

Restricted access

Wolf Lüdemann, Lutz Dörner, Marcos Tatagiba and Madjid Samii

Full access

Madjid Samii, Marcos Tatagiba and Gustavo A. Carvalho

Object

The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).

Methods

The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.

Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.

Conclusions

The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

Restricted access

Florian Roser and Marcos S. Tatagiba

Restricted access

Madjid Samii, Ramesh P. Babu, Marcos Tatagiba and Abolghassem Sepehrnia

✓ Sixteen patients with schwannomas of the jugular foramen were operated on in the Department of Neurosurgery of the Nordstadt Hospital in Hannover, Germany, between 1986 and 1992. Patients with neurofibromatosis were excluded. The records of the 16 patients were retrospectively reviewed. There were five women and 11 men (mean age 43 years) with a symptom duration ranging from 6 months to 20 years (mean 5 years). The predominant symptoms were hearing loss, hoarseness, and cerebellar symptoms. Computerized tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in all 16 patients. Depending on the radiological and surgical features, the tumors were classified into four types: Type A, a tumor primarily at the cerebellopontine angle with minimal enlargement of the jugular foramen (eight cases); Type B, a tumor primarily at the jugular foramen with intracranial extension (two cases); Type C, a primarily extracranial tumor with extension into the jugular foramen (one case); and Type D, a dumbbell-shaped tumor with both intra- and extracranial components (five cases).

A retromastoid suboccipital craniectomy was performed for Type A tumors, and a combined cervical-mastoidectomy for Types B, C, and D. Total tumor removal was achieved in all cases. There was no operative mortality. Postoperative complications were cerebrospinal fluid leakage in one patient and mastoiditis in two patients. The follow-up period ranged from 12 to 42 months (mean 22 months). All patients were alive at the last follow-up review, and CT and/or MR imaging showed no tumor recurrence.

Restricted access

Madjid Samii, Matteo M. Migliori, Marcos Tatagiba and Ramesh Babu

✓ A total of 27 patients with trigeminal schwannoma were treated between 1982 and 1992 at the Neurosurgery Department of Nordstadt Hospital. Twelve cases of solitary schwannoma without any family history or physical stigmata of neurofibromatosis were included and form the basis of this study. There were four women and eight men (mean age 44 years) in this series. Duration of symptoms ranged from 2 months to 6 years. The most frequent symptoms were either pain or numbness of the ipsilateral hemiface. The surgical approach was chosen depending on the tumor type. Tumors that belonged to Type A (five cases), which were predominantly in the middle fossa, were approached using a transsylvian method; Type B (one case), which presented predominantly in the cerebellopontine angle, was operated on via a retrosigmoid suboccipital craniectomy; Type C (five cases), which were dumbbell-shaped extending into both the middle and posterior fossa, were removed via a combined temporal craniotomy—presigmoidal method; and in Type D (one case), in which tumor was primarily extracranial with intracranial extension, an infratemporal extradural approach was undertaken. There was no operative mortality or long-term disability in this series. The follow-up period ranged from 12 to 60 months; during that time magnetic resonance imaging revealed tumor recurrence in two cases after 12 and 48 months, respectively, and these were excised again. An additional 178 cases collected from the world literature are also reviewed and analyzed.

Restricted access

Wolf O. Lüdemann, Richard Obler, Marcos Tatagiba and Madjid Samii

✓ The authors report the case of an 11-year-old boy with a malignant meningioma of the right frontal meninges. The tumor was asymptomatic, despite visible exophytic extracranial growth. Neuroimaging demonstrated an en plaque meningioma bulging into the brain. Six months after the tumor had been totally removed by surgery, an isolated subcutaneous metastasis developed at the right preauricular area of the scalp, originating at the scar left by the first surgery. After removal of this metastasis, radiotherapy was conducted.

To date the follow-up examinations have not revealed any additional metastases. To the best of the authors' knowledge, this is the first report of a seeding of a subcutaneous metastasis in a child with a malignant meningioma. The authors review the literature with reference to malignant meningiomas and their formation of metastasis.

In cases of malignant meningiomas, piecemeal tumor removal carries the risk of iatrogenic cell dissemination even when precautions are taken.

Restricted access

Madjid Samii, Marcos Tatagiba, Jose Piquer and Gustavo A. Carvalho

✓ A total of 40 patients with epidermoid cysts of the cerebellopontine angle (CPA) underwent surgery between 1980 and 1993. Total resection was achieved in 30 cases (75%); in 10 cases (25%) parts of the cyst capsule were left because they adhered to the brainstem and vascular structures of the CPA. One patient with very large bilateral epidermoid cysts, who underwent complete bilateral resection in one stage, died of pulmonary aspiration and infection. As of their latest clinical and radiological follow-up examinations (mean 5.7 years), 93% of the patients are able to lead useful lives. Three cases of cyst regrowth have been observed thus far. Modern radiological tools and microsurgery techniques have considerably improved the completeness of cyst resection and reduced postoperative mortality and morbidity rates; however, there still are some cases in which complete resection is impossible without producing severe neurological deficits.

Restricted access
Restricted access

Wolf Luedemann, Michael Hamm, Ulrike Blömer, Madjid Samii and Marcos Tatagiba

Object. To examine possible side effects of neurotizations in which the phrenic nerve was used, pulmonary function was analyzed pre- and postoperatively in patients with brachial plexus injury and root avulsions.

Methods. Twenty-three patients with complete brachial plexus palsy underwent neurotization of the musculocutaneous nerve, with the phrenic nerve as donor material. Patients who suffered lung contusions as part of the primary injury were excluded from this study. In 12 patients (five left-sided and seven right-sided neurotizations) pre- and postoperative functional parameters were compared and additional body plethysmography was performed more than 12 months postsurgery.

Of the 23, no patient experienced pulmonary problems postoperatively. Nonetheless, pulmonary functional parameters showed a vital capacity in percent of the predicted value of 9.8 ± 6.3% (mean ± standard deviation [SD]) in all patients examined, which was a significant reduction (p = 0.0002).

In right-sided phrenic nerve transfers this reduction was significant, at 14.3 ± 3.3% (mean ± SD), whereas left-sided transfers showed a nonsignificant reduction of 3.6 ± 3.5% (mean ± SD). The observed decrease in vital capacity (VC) correlates with the maximal inspiratory pressure (Pimax) as an indication of clinical significance.

Conclusions. When the right phrenic nerve is used as a donor in neurotization of the musculocutaneous nerve, the patient incurs a higher risk of reduced pulmonary VC. If possible, the left phrenic nerve should be preferred. The Pimax has to be determined preoperatively to avoid any further decrease in the already reduced pulmonary function due to the initial injury.