Exoscopic resection of a parasagittal atypical meningioma

Alejandro Carrasquilla; Artur Zgurov; Mira Salih; Chi Le; Stavros Matsoukas; Rui Feng; Alexander J Schupper; Constantinos Hadjipanayis

doi:10.3171/2023.10.FOCVID23164

Exoscopic resection of a parasagittal atypical meningioma

Neurosurg Focus Video. 2024 Jan 1;10(1):V8. doi: 10.3171/2023.10.FOCVID23164. eCollection 2024 Jan.

Authors

Alejandro Carrasquilla¹, Artur Zgurov¹, Mira Salih¹, Chi Le¹, Stavros Matsoukas¹, Rui Feng¹, Alexander J Schupper¹, Constantinos Hadjipanayis²

Affiliations

¹ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and.
² Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Abstract

This video demonstrates use of the Synaptive 3D exoscope to enhance complex meningioma resection. The patient was a 58-year-old female who presented with new-onset seizures. Workup revealed a parasagittal meningioma over the bilateral cortices. She was started on 750 mg of Keppra twice daily and tapered dexamethasone and discharged. MR venography demonstrated segmental occlusion of the superior sagittal sinus. She then underwent a diagnostic angiogram and tumor Onyx embolization of the bilateral middle meningeal artery feeders. She then underwent a craniotomy for meningioma resection using 3D exoscope guidance. She awoke with a stable examination in the intensive care unit and worked with physical therapy on postoperative day 1. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23164.

Keywords: 3D exoscope; WHO grade II; bilateral parasagittal atypical meningioma; brain tumor; craniotomy; neuronavigation; superior sagittal sinus; surgical efficiency and ergonomics.