140
Fig. 10.4 With this
same exposure, the
jugular foramen can be
seen. Inspection of the
superior portion of the
tumor allows
visualization of the CN
IX, X complex with an
appreciation for the
distortion of normal
anatomic relationships
caused by the tumor. CN
XII can be seen
displaced posteriorly (in
comparison to the CN
IX and X) as it is draped
over the tumor surface
Fig. 10.5 Depending on
the particular anatomy
of the tumor and
locations of the neural
and vascular structures,
the surgeon may work
through one or more
surgical corridors that
are offered. Debulking
continues through these
various approaches
As in most meningioma surgeries, the princi-
ples of using sharp dissection and measured
countertraction cannot be overemphasized.
Ultrasonic aspirators must be used with caution,
as they will not respect perforators or buried
arteries and nerves (Fig. 10.6).
Once the bulk of visible tumor is removed,
one can then address the dural base (Figs. 10.7,
10.8). It is not at all uncommon for a segment
of meningioma to extend in the interdural
space, which is why the dural base has to be
resected as completely as possible. The depth
of the resection rarely needs to go through and
through to the bone, as FMM rarely invades
that deeply.
Outcomes and Complications
Over the past 20 years, the overall reported mor-
tality for FMM resection is 6.2% with a lower
rate of permanent morbidity in the far-lateral
approach as compared to the extreme-lateral
approach (0–17% vs. 21–56%) [ 8 ]. In Yasargil’s
review of 114 FMMs, a good outcome was
achieved in 69% of patients, fair in 8%, and poor
in 10% [ 24 ]. In larger series (>10 patients), neu-
rological improvement was seen in 70–100% of
patients [ 8 ]. Cerebellar and long tract signs tend
to improve postoperatively; however, only a
minority of patients experience recovery of pre-A.M. Richardson et al.