Centrifugal opening of dura for total extirpation of large convexity meningiomas: modifying the "classic" technique to prevent injury to the adjacent brain and veins.

Abstract

Traditionally, the dura is opened along the margin of a convexity meningioma, jeopardizing the adjacent herniating brain and compressed veins in case of large meningioma. In this work, we describe a technique to open the dura centrifugally over convexity meningiomas. Fifteen cases of large convexity meningiomas were operated on using the new technique. In our technique, the involved dura over large convexity meningiomas was opened in a centrifugal manner just short of the tumor-brain interface. The tumor was decompressed while preserving the arachnoid. The involved dura, along with the cuff of adjoining normal dura, was cut after tumor excision. Gross total excision could be achieved in all cases without any added deficits. There was arachnoid breach in three patients with insignificant venous injury in one. The preoperative symptoms improved in all. In this technique, the dura provides a natural barrier to protect the adjacent compressed brain and veins, thus avoiding handling the compressed adjacent neurovascular structures during surgery for large convexity meningioma without compromising the extent of resection.