1
|
Chen H, Xu Y, Shi J, Zhang Y, Qian C, Luo Z. The Extended Pterional Approach Allows Satisfactory Results for the Resection of Huge Medial Sphenoid Ridge Meningioma. World Neurosurg 2023; 176:e306-e313. [PMID: 37224955 DOI: 10.1016/j.wneu.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the surgical method and efficacy of the extended pterional approach in the resection of huge medial sphenoid ridge meningiomas (MSRMs). METHODS Retrospective analysis of clinical data from 41 patients diagnosed with MSRMs (diameter ≥4.0 cm) from Nanjing Brain Hospital between January 2012 and February 2022 was conducted. Within 24 hours after surgery, head computed tomography and magnetic resonance imagingwere reviewed to evaluate the extent of tumor resection based on Simpson grading. Cranial magnetic resonance imagingwas repeated 3 to 60 months after surgery to assess tumor recurrence or progression. Preoperative, discharge, and follow-up Karnofsky functional status scores (KPS) were assessed to determine patients' functional status. Repeated-measures analysis of variance was utilized to compare KPS at preoperative, hospital discharge, and final follow-up. RESULTS The 41 selected cases included 38 cases (92.7%) of Simpson I-III resection and 3 cases (7.3%) of Simpson IV resection. All the cases had typical pathological features and definite pathological diagnoses. There were 2 recurrent tumors and 4 progressed tumors when the patients were followed up from 3 months to 60 months after operations. The results demonstrated that the KPS score at the final follow-up (91.4 ± 9.6) was higher than at hospital discharge (85.3 ± 8.9) and preoperation (78.2 ± 8.5) (F = 69.46, P = 0.033). CONCLUSIONS The use of the extended pterional approach in the resection of huge MSRMs appears to be an effective surgical method. Careful dissection and preservation of vascular and neural structures, as well as meticulous microsurgical techniques in managing cavernous sinus tumors, can lead to reduced surgical complications and improved treatment outcomes.
Collapse
Affiliation(s)
- Hairong Chen
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yang Xu
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jianwei Shi
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yansong Zhang
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chunfa Qian
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhengxiang Luo
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| |
Collapse
|
2
|
Armocida D, Catapano A, Palmieri M, Arcidiacono UA, Pesce A, Cofano F, Picotti V, Salvati M, Garbossa D, D’Andrea G, Santoro A, Frati A. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie. Brain Sci 2022; 12:brainsci12070817. [PMID: 35884624 PMCID: PMC9313316 DOI: 10.3390/brainsci12070817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.
Collapse
Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
- Correspondence: ; Tel.: +39-393-287-4496
| | - Antonia Catapano
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Pesce
- Neurosurgery Unit, Ospedale Santa Maria Goretti, Via Guido Reni 1, 04100 Latina, LT, Italy;
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, Viale Oxford, 81, 00133 Roma, RM, Italy;
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Giancarlo D’Andrea
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Frati
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
| |
Collapse
|
3
|
Lessa SS, Chang Mulato JE, Dória-Netto HL, Wuo-Silva R, Filho JMC, Chaddad-Neto F. Microsurgery for a medial left giant lesser sphenoid wing meningioma complicated by postoperative vasospasm of the ipsilateral supraclinoid carotid artery. Surg Neurol Int 2022; 13:113. [PMID: 35509597 PMCID: PMC9062936 DOI: 10.25259/sni_90_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sphenoid wing meningiomas present close contact with intracranial arteries and have great potential for vascular complications. Here, we describe the case of a patient who presented a medial left giant lesser sphenoid wing meningioma involving the supraclinoid carotid artery. One week after surgery, she developed vasospasm whose treatment using milrinone achieved excellent results. Case Description: This is the case of a 23-year-old female with a large meningioma of the middle third of the lesser wing of the left sphenoid. Furthermore, the patient had symptoms of headache, diplopia, and left amaurosis (Video 1). The lesion involved the supraclinoid left carotid artery, causing significant stenosis of the vessel. The patient underwent surgical treatment without complications. One week after the procedure, she evolved with lowered level of consciousness, complete, and proportionate right hemiparesis and right Babinski’s sign. Angiographic study demonstrated significant stenosis of the left supraclinoid artery. After endovascular treatment with milrinone, the patient evolved with immediate improvement of signs and symptoms. Conclusion: Giant meningiomas with vascular involvement involve a higher risk of postoperative vascular complications. Other studies should be carried out to predict these complications and thus develop preventive measures.
Collapse
Affiliation(s)
| | | | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo,
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo,
- Hospital Beneficência Portuguesa de São Paulo, São Paulo – SP, Brazil
| |
Collapse
|