Anish M Singh

Complete Excision of Huge Meningioma with Intraoperative Intermittent External Carotid Occlusion: A Case Report

18 Meningioma is one of the most common brain tumors and it is often highly vascular. The main blood supply to the meningioma is from different branches of external carotid artery through meningeal vessels. Pre-operative embolization of meningioma to devascularize the tumor to facilitate its total excision is a common procedure. At times it may not be possible due to various reasons especially in Nepalese context. Here we present a case of giant meningioma, totally excised by intraoperative intermittent clamping of external carotid artery without sacrifi cing it.

Complete Excision of Giant Dumbbell Schwannoma without Neurophysiological Monitoring

Schwannomas are the most common tumors of spine. Dumbbell schwannomas are more commonly found in cervical spine. Complete excision of swchnnoma is mandatory to prevent its recurrence. However, at times it becomes diffi cult and rather impossible in certain cases of giant schwannomas. It is more so when there is no intraopertive neurophysiological monitoring. In this regard here we present 11-year-old boy with giant dumbbell schwannoma at the level of C2 cervical spine. The boy presented with progressive left upper limb weakness. He started having a lump, which got more prominent with time, on the back surface of left upper neck. MRI showed mass at C2 starting from left intradural space extending to extraforaminal space. The mass was giant measuring about 100 mm and was homogenously enhanced with contrast (Figure 1). Surgery was planned through extraforaminal approach. A curvilinear incision was given with the vertical limb of incision in the midline. Extraforaminal giant mass was approached fi rst. Surrounding dissection of the mass was done. Foramen was approached and foraminotomy was done along with small hemilaminotomy of C2 on left side. Total mass was excised in block through the foramen doing durotomy. Neurophysiological monitoring is essential intraoperatively while operating on such cases to minimize possible neurological defi cit.2 However, in our context, Complete Excision of Giant Dumbbell Schwannoma without Neurophysiological Monitoring Prabin Shrestha, MD, PhD Department of Neurosurgery B&B Hospital, Gwarko Lalitpur, Nepal