• Neurocirugia · May 2014

    Case Reports

    Full endoscopic endonasal transclival approach: meningioma attached to the ventral surface of the brainstem.

    • Juan Antonio Simal Julian, Pablo Sanromán Álvarez, Pablo Miranda Lloret, Estela Plaza Ramirez, Pedro Pérez Borreda, and Carlos Botella Asunción.
    • Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain. Electronic address: juanantonio.simal@gmail.com.
    • Neurocirugia. 2014 May 1; 25 (3): 140-4.

    BackgroundIntracranial meningiomas without dural attachment (MWODA) are rare entities. We present the first case published, to the best of our knowledge, regarding a MWODA attached to the ventral surface of the brainstem. This location makes the patient subsidiary to treatment through an expanded endonasal transclival approach.Clinical PresentationA 16-year-old female with suspected diagnosis of recurrence of a clear cell meningioma (CCM) at a distance from the initial lesion, located on the premedullary cistern. The patient underwent a pure endoscopic low transclival approach. The attachment to the ventral surface of the brainstem was confirmed intraoperatively. Postoperative MRI confirmed gross total resection and treatment was complemented with adjuvant fractionated stereotactic radiotherapy. No complications related to the procedure were observed.ConclusionMWODA may appear attached to the ventral brainstem. The expanded endonasal approach to the clivus provides a critical anatomical advantage in the treatment of medial lesions, even ventral meningiomas, to the lower cranial nerves. Reconstruction principles must be strictly respected to reduce complications.Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

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