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Anterior petrosal approach for petroclival solitary plasmacytoma
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How to cite this article: de Melo Junior JO, Lavradas Junior LD, Landeiro JA. Anterior petrosal approach for petroclival solitary plasmacytoma. Surg Neurol Int 2022;13:201.
Primary solitary plasmacytoma (PSP) of the skull base is a rare localized monoclonal plasma cell dyscrasia with normal or low plasma cell infiltration. Differentiating from other skull base tumors based on radiologic findings is difficult due to nonspecific features. PSP has a better prognosis after surgical resection and adjuvant radiotherapy, unless the tumor progresses to multiple myeloma (MM). Nonetheless, 50–60% progress to MM within a median time of 2 years. Gross total resection (GTR) for PSP is controversial for improving overall survival. However, if the lesion is easily accessible, for example, nonskull base lesion, GTR is still advocated.
A 67-year-old male patient presented with right occipital neuralgia and diplopia in the last year. Neurological examination revealed mild abducens paresis on the right side. Brain MRI scan showed a large petroclival bony extradural mass lesion on the right side, with homogeneous enhancement, extending from the dorsum sellae to the ipsilateral occipital condyle and involving the petrous carotid artery. Brain CT scan revealed an osteolytic lesion without intratumoral calcifications, sclerotic border, or periosteal reaction. Anterior petrosal approach was performed and GTR was achieved. The patient had good postoperative outcome and improvement of symptoms. Postoperative MRI revealed GTR. Total body imaging work-up and immunohistochemistry confirmed PSP.
Although the extent of resection in the outcome is controversial, maximal safe resection of skull base PSP should be considered to improve symptoms and quality of life.
Anterior petrosal approach
[Video 1]-Available on:
00:00 – Introduction
00:46 – Case presentation
01:02 – Preoperative imaging
01:53 – Anterior petrosal approach, landmarks in a cadaver model
03:10 – Anterior petrosal approach, surgical steps
04:03 – Surgical video
06:23 – Postoperative imaging
06:29 – Outcome and conclusion.
Video 1:Video 1:Contrast-enhanced axial T1-weighted MRI showed a huge extradural mass lesion at the skull base, centered in the right petroclival region, exhibiting homogeneous enhancement. The tumor extended from the dorsum sellae to the ipsilateral occipital condyle, involving the ipsilateral petrous apex, petrous carotid artery, Meckel’s cave and sphenoid sinus, in close relation to the jugular foramen and foramen magnum
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Conflicts of interest
There are no conflicts of interest.
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