Diagnosis
Meningioma of the clivus (Blumenbach's clivus), WHO Grade I. Hypesthesia and numbness affecting the right side of the face.
Patient:
Female, 53 years old, Kazakhstan
Physician:
Prof. Dr. med. Martin Scholz, Chief Physician, Department of Neurosurgery, Duisburg Clinic
Expert Opinion by Neurosurgeon Prof. Martin Scholz:
In this case, we are managing a moderate-sized meningioma located along the right side of Blumenbach's clivus, which is currently exerting mass effect on the brainstem.
To safely resect this tumor, we utilize a microsurgical approach performed with the patient in a semi-sitting position, integrated with intraoperative neurophysiological monitoring (evoked potentials) and continuous cranial nerve monitoring. This advanced setup significantly reduces the surgical risk to adjacent critical neural structures, specifically the abducens (CN VI), trigeminal (CN V), and vestibulocochlear (CN VIII) nerves. Our team is fully prepared to perform this complex procedure at our department.
Patient’s Inquiries:
- How urgently does this surgery need to be performed, and how much time do I have to prepare?
- How complex is this type of surgical intervention?
- What are the potential postoperative complications or side effects?
Doctor's Answers:
Regarding Urgency & Timeline: Clival meningiomas are typically slow-growing tumors, progressing at an average rate of 1 to 2 millimeters per year. Therefore, you have sufficient time to carefully plan your travel arrangements and clinical admission without immediate risk.
Regarding Complexity & Approach: Operating on lesions of the clivus is technically demanding. Fortunately, in your case, the tumor remains relatively compact. Utilizing a suboccipital lateral approach in the sitting position, paired with continuous intraoperative nerve monitoring, allows us to achieve a favorable and safe outcome.
Regarding Potential Side Effects: Because the tumor tissue intimately encases the abducens nerve, there is a possibility of transient postoperative diplopia (double vision), which typically resolves during recovery.
Estimated Cost of Treatment: €31,500
Treatment Performed & Clinical Outcome
The patient underwent successful microsurgical resection of the space-occupying lesion along the right Blumenbach's clivus.
Postoperative monitoring was initially conducted in the intensive care unit. Follow-up CT scans confirmed no evidence of intracranial hemorrhage, ischemic stroke, or disruption of cerebrospinal fluid (CSF) dynamics. Standard benign postoperative intra- and extracranial pneumocephalus (air collection) was noted. On the first postoperative day, the patient was safely transferred to the general neurosurgical ward.
Mobilization progressed smoothly without major clinical complications. Pre-existing numbness on the right side of the face persisted postoperatively; therefore, targeted sensorimotor physical therapy was initiated under the guidance of our rehabilitation specialists.
Sutures were removed on the tenth day after surgery, and the patient was discharged in good clinical condition under local physician follow-up.
Actual Cost of Treatment: €29,700