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Nowak S, Matthes M, Baldauf J, Schroeder HWS. Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01074. [PMID: 38385687 DOI: 10.1227/ons.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgery of posterior fossa meningiomas is extremely challenging even for experienced skull base surgeons because of the close proximity to cranial nerves and tight spaces. Endoscope-assisted surgery for posterior fossa meningiomas can enable a high degree of tumor resection even when using small approaches. This study describes the advantage of endoscope-assisted microneurosurgery in resection of posterior fossa skull base meningiomas and the clinical outcome. METHODS All endoscope-assisted surgeries for resection of posterior fossa meningiomas performed between 2002 and 2016 in our department were retrospectively analyzed. For data acquisition, the patient files were used. Tumor size and extent of resection were evaluated on pre- and postoperative magnetic resonance imaging. The value of endoscope assistance was assessed according to the intraoperative videos and the surgical notes. Complications and long-term outcomes were evaluated. RESULTS We identified 39 female and 10 male patients. The mean age of the patients at the time of surgery was 55 years, ranging from 25 to 78 years. The mean follow-up was 93.8 months. A total of 41% of the tumors were large to giant. The retrosigmoid approach was used in most patients (45). A gross total resection could be achieved in 38 patients (78%). In 11 patients (22%), a near total resection was performed. In 27 patients (55%), a hidden residual tumor, which could not been visualized with the operating microscope, was identified with the endoscope. In 6 patients (22.2%), the internal auditory canal was visualized, in 9 patients (33.3%), the Meckel's cave was visualized, and in 5 patients (18.5%), both were visualized under endoscope assistance. In 26 of those patients (96.3%), the residual tumor was resected under endoscopic view. CONCLUSION Endoscope-assisted surgery for posterior fossa skull base meningiomas enables a high degree of tumor resection, avoids more invasive skull base approaches, and reduces the amount of cerebellar retraction.
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Affiliation(s)
- Stephan Nowak
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Germany
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Cheng Y, Song Y, Yang W, Wang L, Li X, Bai J, Xiao X. The Evolution of Anterior Transpetrosal Approach for the Treatment of Petroclival Meningiomas: A Single-Center 128-Case Experience. World Neurosurg 2024; 181:e35-e44. [PMID: 37088415 DOI: 10.1016/j.wneu.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The profound understanding of anterior transpetrosal approach (ATPA) is increasingly used to treat petroclival meningiomas (PCMs). We introduce the evolution of ATPA and the outcomes of PCMs treatment. METHODS Between January 2013 and December 2019, 128 patients with PCMs underwent surgery. According to tumor extension, we classified the 128 patients into 5 types (I-V), introduced key technologies of ATPA into different types for the first time, and achieved a supreme surgical technology. Clinical data, radiological findings, surgical treatments, complications, and patient outcomes were retrospectively analyzed. RESULTS A total of 22 (17.2%), 44 (34.4%), 25 (19.5%), 29 (22.7%), and 8 (6.3%) patients had type I, II, III, IV, and V disease, respectively. Tumors were gross totally removed (Simpson I and II) in 100 patients (78.1%), subtotally removed (Simpson III) in 20 patients (15.6%), and partially removed (Simpson IV) in 8 patients (6.3%). The progression or recurrence rates were 5% (5/100) for gross totally removed, 22.3% (6/20) for subtotally removed, and 62.5% (5/8; 1 died) for partially removed. According to the Karnofsky Performance Scale and Glasgow Outcome Scale, 108 patients had good recovery (84.4%, 108/128) and 115 were independent (89.8%, 115/128) at the end of follow-up. CONCLUSIONS Because some key technologies were used in ATPA, the application of ATPA was extended, and greater tumor resection and nerve function protection could be achieved in the treatment of PCMs.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yiming Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, China
| | - Leiming Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoran Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Chen LP, Li D, Li XJ, Song LR, Zhang LW, Wu Z, Zhang JT, Wang L. Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve. Acta Neurochir (Wien) 2023; 165:2885-2893. [PMID: 37581723 DOI: 10.1007/s00701-023-05735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve. METHODS A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded. RESULTS This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved. CONCLUSION Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.
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Affiliation(s)
- Liang-Peng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Xiao-Jie Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Lai-Rong Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China.
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China.
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Sharma R, Singh J, Katiyar V, Narwal P, Suri V, Raheja A, Suri A. Correlation of Surgical Outcomes of Petroclival Meningiomas with Clinicoradiologic Parameters and Molecular and Chromosomal Alterations. World Neurosurg 2023; 171:e837-e845. [PMID: 36587896 DOI: 10.1016/j.wneu.2022.12.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify clinical, radiologic, intraoperative, histopathologic, and molecular factors that might affect the surgical outcome of petroclival meningiomas. METHODS Medical records of 53 cases of petroclival meningiomas operated from 2003 to 2021 were reviewed for clinicoradiologic and molecular factors that were correlated with extent of resection. RESULTS Modified Dolenc-Kawase anterior transpetrous rhomboid (44, 83.0%) was the most commonly used approach, followed by retrosigmoid (2, 3.8%) and combined (7, 13.2%) approaches. Hypointense tumors on T2-weighted magnetic resonance imaging (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.70-20.41) and presence of brainstem edema (OR 4.53; 95% CI 1.36-15.12) were found to be significant factors increasing the likelihood of subtotal resection (STR; P = 0.004 and P = 0.011, respectively). In the presence of both tumor T2 hypointensity and brainstem edema, there was a significant increase in the likelihood of STR (P = 0.001; OR 25; 95% CI 3.52-177.48). Of the 16 cases for which molecular analysis was performed, no specimen was found to have pTERT, AKT-1 E17K, and SMO L412F and W535L mutations. All (100%) the patients harboring H3K27me3 loss and/or hemizygous CDKN2A deletion had cavernous sinus extension compared with 62.5% of patients without H3K27me3 loss and 72.7% with hemizygous CDKN2A retention. Similarly, hemizygous CDKN2A deletion and H3K27me3 loss were associated with an increase in the rate of brainstem edema from 27.3% to 60% and 25% to 50%, respectively. CONCLUSIONS T2 hypointense tumor and brainstem edema on preoperative imaging are significant predictors of STR. H3K27me3 loss and hemizygous CDKN2A deletion may be associated with cavernous sinus extension, suggesting their role in tumor spread.
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Affiliation(s)
- Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Singh
- Neuropathology Laboratory, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Narwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Neuropathology Laboratory, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Westphal M, Saladino A, Tatagiba M. Skull Base Meningiomas. Adv Exp Med Biol 2023; 1416:47-68. [PMID: 37432619 DOI: 10.1007/978-3-031-29750-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Skull base meningiomas are among the most challenging meningiomas to treat clinically due to their deep location, involvement or encasement of adjacent essential neurovascular structures (such as key arteries, cranial nerves, veins, and venous sinuses), and their often-large size prior to diagnosis. Although multimodal treatment strategies continue to evolve with advances in stereotactic and fractionated radiotherapy, surgical resection remains the mainstay of treatment for these tumors. Resection of these tumors however is challenging from a technical standpoint, and requires expertise in several skull-base surgical approaches that rely on adequate bony removal, minimization of brain retraction, and respect for nearby neurovascular structures. These skull base meningiomas originate from a variety of different structures including, but are not limited to: the clinoid processes, tuberculum sellae, dorsum sellae, sphenoid wing, petrous/petroclival area, falcotentorial region, cerebellopontine angle, and foramen magnum. In this chapter, we will cover the common anatomical areas in the skull base from which these tumors arise, and the specific or optimal surgical approaches and other treatment modalities for meningiomas in these such locations.
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Affiliation(s)
- Manfred Westphal
- Department of Neurological Surgery, UK Eppendorf, Hamburg, Germany.
| | - Andrea Saladino
- Department of Neurological Surgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
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Krischek B, Goldbrunner R. Paradigm Shift in the Treatment of Meningiomas. Adv Exp Med Biol 2023; 1416:1-4. [PMID: 37432615 DOI: 10.1007/978-3-031-29750-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Meningiomas are the most common brain tumor in adults with rising incidence rates due to an aging population globally, increased availability of neuroimaging, and increased awareness of this condition by treating clinicians and primary care physicians. Surgical resection remains the mainstay of treatment, with adjuvant radiotherapy reserved for higher grade meningiomas or tumors that undergo incomplete resections. Whereas these tumors were classically defined by their histopathological features and subtypes, recent work has uncovered the molecular alterations that may lead to tumor development and have important prognostic implications. However, there remain important clinical questions regarding the management of meningiomas and current clinical guidelines continue to evolve as additional studies add onto the growing body of work that enables us to better understand these tumors.
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Affiliation(s)
- Boris Krischek
- Department of Neurosurgery, Hopitaux Robert Schuman, Luxembourg, Luxembourg
- Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany.
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Pattankar S, Misra BK. Treatment Strategies and Current Results of Petroclival Meningiomas. Adv Tech Stand Neurosurg 2023; 48:251-275. [PMID: 37770687 DOI: 10.1007/978-3-031-36785-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Petroclival meningiomas (PCMs) are complex skull-base tumors that continue to pose a formidable surgical challenge to neurosurgeons because of their deep-seated location/intimate relationship with the brainstem and neurovascular structures. The advent of stereotactic radiosurgery (SRS), along with the shifting of management goals from complete radiological cure to maximal preservation of the patient's quality of life (QOL), has further cluttered the topic of "optimal management" in PCMs. Not all patients with PCM need treatment ("watchful waiting"). However, many who reach the neurosurgeons with a symptomatic disease need surgery. The goal of the surgery in PCMs is a GTR, yet this can be achieved in only less than half of the patients with acceptable morbidity. The remainder of the patients are better treated by STR followed by SRS for residual tumor control or close follow-up. A small subset of patients with PCM may be best treated by primary SRS. In this chapter, we have tried to summarize the scientific evidence pertaining to the management of PCMs (including the senior author's series), particularly those regarding the available treatment strategies and current outcomes, and discuss the decision-making process to formulate an "optimal management" plan for individual PCMs.
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Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery and Gamma Knife Radiosurgery, P D Hinduja Hospital and MRC, Mumbai, India
| | - Basant K Misra
- Department of Neurosurgery and Gamma Knife Radiosurgery, P D Hinduja Hospital and MRC, Mumbai, India.
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Tuleasca C, Ruess D, Ruge M, Régis J. Stereotactic Therapies for Meningiomas. Adv Exp Med Biol 2023; 1416:107-119. [PMID: 37432623 DOI: 10.1007/978-3-031-29750-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Although surgery remains the mainstay of treatment for most meningiomas, radiotherapy, specifically stereotactic radiosurgery, has become more commonplace as first-line therapy for select meningioma cases, particularly small meningiomas in challenging or high-risk anatomic locations. Radiosurgery for specific groups of meningiomas have been found to provide local control rates comparable to surgery alone. In this chapter stereotactic techniques for the treatment of meningiomas such as stereotactic radiosurgery by using Gamma knife or Linear Accelerator-based techniques (modified LINAC, Cyberknife, etc.) as well as stereotactically guided implantation or radioactive seeds for brachytherapy are introduced.
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Affiliation(s)
- Constantin Tuleasca
- Clinical Neurosurgery Service, Centre Hospitalier Universitaire de Lille, Roger Salengro Hospital, Lille, France
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Daniel Ruess
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Jean Régis
- Clinical Neurosurgery Service, Centre Hospitalier Universitaire de Lille, Roger Salengro Hospital, Lille, France.
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland.
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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Kienzler JC, Fandino J. Adaptive Hybrid Surgery Experiences in Benign Skull Base Tumors. Brain Sci 2022; 12:1326. [PMID: 36291260 DOI: 10.3390/brainsci12101326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The treatment of benign skull base tumors remains challenging. These tumors are often located in close relationship to critical structures. Therefore, radical resection of these tumors can be associated with high morbidity. Multimodal treatment concepts, including controlled partial tumor resection followed by radiosurgery, should be considered. Methods: Adaptive hybrid surgery analysis (AHSA) is an intraoperative tool that has been introduced for the automatic assessment of tumor properties, and virtual real-time radiosurgical treatment simulation and continuous feasibility analysis of adjuvant radiosurgery. The AHSA method (Brainlab®, Munich, Germany) was applied to five patients who underwent partial resection of a benign skull base tumor. Tumor volumetry was obtained on pre- and postoperative MR scans. Organs at risk were, preoperative, automatically delineated with atlas mapping software (Elements® Segmentation Cranial), and adaptations were made if necessary. Results: Five patients with benign skull base lesions underwent planned partial tumor resection in a multimodal therapeutic surgery followed by radiosurgery. The preoperative tumor volumes ranged between 8.52 and 25.2 cm3. The intraoperative residual tumor volume measured with the AHSA® software ranged between 2.13–12.17 cm3 (25–52% of the preoperative tumor volume). The intraoperative automatic AHSA plans of the remaining tumor volume suggested, in all five patients, that safe hypofractionated radiation was feasible. Patients were followed for 69.6 ± 1.04 months, and no complications occurred after the patients were treated with radiation. Conclusions: Intraoperative SRS planning based on volumetric assessments during resection of skull base tumors using AHSA® is feasible and safe. The AHSA method allows the neurosurgeon to continuously evaluate the feasibility of adjuvant radiosurgery while planning and performing a surgical resection. This method supports the treatment strategy of a complementary approach during surgical resection of complex skull base tumors and might contribute to preventing surgical and radiosurgical complications.
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Schackert G, Lenk M, Kirsch M, Hennig S, Daubner D, Engellandt K, Appold S, Podlesek D, Sandi-gahun S, Juratli TA. Surgical results of 158 petroclival meningiomas with special focus on standard craniotomies. J Neurooncol. [PMID: 36103000 PMCID: PMC9622548 DOI: 10.1007/s11060-022-04105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
Objective The goal of this retrospective study is the evaluation of risk factors for postoperative neurological deficits after petroclival meningioma (PCM) surgery with special focus on standard craniotomies. Materials and methods One-hundred-fifty-eight patients were included in the study, of which 133 patients suffered from primary and 25 from recurrent PCM. All patients were operated on and evaluated concerning age, tumor size, histology, pre- and postoperative cranial nerve (CN) deficits, morbidity, mortality, and surgical complications. Tumor-specific features—e.g., consistency, surface, arachnoid cleavage, and location—were set in a four-grade classification system that was used to evaluate the risk of CN deficits and tumor resectability. Results After primary tumor resection, new CN deficits occurred in 27.3% of patients. Preoperative ataxia improved in 25%, whereas 10% developed new ataxia. Gross total resection (GTR) was achieved in 59.4%. The morbidity rate, including hemiparesis, shunt-dependence, postop-hemorrhage, and tracheostomy was 22.6% and the mortality rate was 2.3%. In recurrent PCM surgery, CN deficits occurred in 16%. GTR could be achieved in three cases. Minor complications occurred in 20%. By applying the proposed new classification system to patients operated via standard craniotomies, the best outcome was observed in type I tumor patients (soft tumor consistency, smooth surface, plane arachnoid cleavage, and unilateral localization) with GTR in 78.7% (p < 0.001) and 11.9% new CN deficits (p = 0.006). Conclusion Standard craniotomies as the retrosigmoid or subtemporal/pterional approaches are often used for the resection of PCMs. Whether these approaches are sufficient for GTR—and avoidance of new neurological deficits—depends mainly on the localization and intrinsic tumor-specific features. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04105-5.
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Corniola MV, Meling TR. Management of Recurrent Meningiomas: State of the Art and Perspectives. Cancers (Basel) 2022; 14:cancers14163995. [PMID: 36010988 PMCID: PMC9406695 DOI: 10.3390/cancers14163995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Intracranial meningiomas account for 30% to 40% of the primary lesions of the central nervous system. Surgery is the mainstay treatment whenever symptoms related to an intra-cranial meningioma are encountered. However, the management of recurrences after initial surgery, which are not uncommon, is still a matter of debate. Here, we present the alternatives described in the management of meningioma recurrence (radiotherapy, stereotaxic radiosurgery, protontherapy, and chemotherapy, among others). Their overall results are compared to surgery and future perspectives are presented. Abstract Background: While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods: A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results: The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions: Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival.
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Affiliation(s)
- Marco Vincenzo Corniola
- Service de Neurochirurgie, Pôle des Neurosciences, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France
- Faculté de Médecine, Université de Rennes 1, 35000 Rennes, France
- Faculté de Médecine, Université de Genève, 1205 Geneve, Switzerland
- Laboratoire du Traitement de Signal, Unité Médicis, INSERM UMR 1099 LTSI, Université de Rennes 1, 35000 Rennes, France
| | - Torstein R. Meling
- Faculté de Médecine, Université de Genève, 1205 Geneve, Switzerland
- Department of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Besta NeuroSim Center, Fondazione IRCCS, Istituto Neurologico Carlo Basta, 20133 Milano, Italy
- Correspondence:
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Wach J, Lampmann T, Güresir Á, Vatter H, Herrlinger U, Becker A, Toma M, Hölzel M, Güresir E. Increased MIB-1 Labeling Index Is Associated with Abducens Nerve Morbidity in Primary Sporadic Petroclival Meningioma Surgery: Beyond Location and Approach. Curr Oncol 2022; 29:5026-41. [PMID: 35877258 DOI: 10.3390/curroncol29070398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/22/2022] Open
Abstract
Abducens nerve palsy is a severe dysfunction after petroclival meningioma (PC MNG) surgery. The objective of this investigation was to analyze abducens nerve outcomes in patients who underwent the retrosigmoid approach in relation to the MIB-1 index. Thirty-two patients with primary sporadic PC MNG were retrospectively analyzed. Mean follow-up was 28.0 months. Analysis of the MIB-1 index was performed to evaluate the abducens nerve outcome. An optimal MIB-1 index cut-off value (<4/≥4) in the association with postoperative CN VI palsy was determined by ROC analysis (AUC: 0.74, 95% CI: 0.57−0.92). A new-onset CN VI palsy was present in 7 cases (21.88%) and was significantly associated with an increased MIB-1 index (≥4%, p = 0.025) and a peritumoral edema in the brachium pontis (p = 0.047) which might be caused by the increased growth rate. Tumor volume, cavernous sinus infiltration, auditory canal invasion, and Simpson grading were not associated with new CN VI deficits. Six (85.7%) of the 7 patients with both an increased MIB-1 index (≥4%) and new abducens nerve palsy still had a CN VI deficit at the 12-month follow-up. A peritumoral edema caused by a highly proliferative PC MNG with an elevated MIB-1 index (≥4%) is associated with postoperative abducens nerve deficits.
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Rios-Vicil CI, Jean WC. Commentary: Microsurgical Resection of a Petroclival Meningioma via a Suboccipital Approach: Technical Nuances and Anatomical Considerations: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e56-e57. [PMID: 35726939 DOI: 10.1227/ons.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022] Open
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Isolan GR, Wayhs SY, Araújo RLD, de Aguiar PHP, Pinto JAR, Marques VMO. Abordajes quirúrgicos de meningiomas petroclivales parte 1: anatomía microquirúrgica. Surg Neurol Int 2022; 13:277. [PMID: 36101859 PMCID: PMC9465442 DOI: 10.25259/sni_413_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/04/2022] Open
Abstract
Antecedentes:
Los meningiomas petroclivales son tumores benignos cuyo tratamiento microquirúrgico es uno de los mayores retos de la neurocirugía. El conocimiento profundo de la anatomía microquirúrgica y los abordajes quirúrgicos para el tratamiento de estos tumores es la primera etapa de aprendizaje para un manejo ideal. Este artículo se divide en dos partes: la primera parte presentará los resultados de la anatomía microquirúrgica relevantes para el manejo de los meningiomaspetroclivales. En la segunda parte, los autores correlacionan esta anatomía con 30 casos de meningiomas petroclivales operados por el autor principal (GRI).
Métodos:
Se disecaron ocho cabezas de cadáveres utilizando un microscopio quirúrgico en el laboratorio de microcirugía de la University of Arkansas for Medical Sciences. En los cerebros y en todas las cabezas, se inyectó silicona de colores para resaltar la diferencia entre las arterias y las venas. Los cadáveres fueron colocados en un fijador craneal tipo Mayfield, simulando el posicionamiento quirúrgico de los abordajes craneo-órbito-cigomatico, petrosectomía anterior y posterior y retrosigmoideo. Otras ocho cabezas de cadáveres fueron formolizadas y con los vasos inyectados con silicona de colores. Se realizaron los abordajes petroso anterior, petroso posterior y craneo-órbito-cigomático.
Resultados:
En el manejo de los meningiomas petroclivales se utilizan tres abordajes quirúrgicos principales: abordaje pterional y sus variantes, abordaje petroso y sus variantes y abordaje retrosigmoideo. Los abordajes endonasales endoscópicos extendidos tienen factores limitantes para su uso en este tipo de procedimiento. Para racionalizar la elección del abordaje quirúrgico, dividimos el clivus en tercios superior, medio e inferior.
Conclusíon:
Varios abordajes quirúrgicos dan acceso a la regiónpetroclival. El conocimiento práctico de la anatomía de esta región adquirido en el laboratorio de microcirugía es parte fundamental del cirujano que se propone operar meningiomas petroclivales.
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Affiliation(s)
- Gustavo Rassier Isolan
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
| | - Sâmia Yasin Wayhs
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
| | - Ricardo Lopes de Araújo
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
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Zhang C, Zhang T, Ge L, Li Z, Chen J. Management of Posterior Fossa Tumors in Adults Based on the Predictors of Postoperative Hydrocephalus. Front Surg 2022; 9:886438. [PMID: 35722528 PMCID: PMC9198439 DOI: 10.3389/fsurg.2022.886438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to identify the predictors of postoperative hydrocephalus in patients with posterior fossa tumors (PFTs) and guide the management of perioperative hydrocephalus.MethodsWe performed a single-institution, retrospective analysis of patients who underwent resection of PFTs in our department over a 10-year period (2011–2021). A total of 682 adult patients met the inclusion criteria and were divided into either a prophylactic external ventricular drainage (EVD) group or a nonprophylactic-EVD group. We analyzed data for the nonprophylactic-EVD group by univariate and multivariate analyses to identify predictors of postoperative acute hydrocephalus. We also analyzed all cases by univariate and multivariate analyses to determine the predictors of postoperative ventriculoperitoneal (VP) shunt placement.ResultsTumor infiltrating the midbrain aqueduct [P = 0.001; odds ratio (OR) = 9.8], postoperative hemorrhage (P < 0.001; OR = 66.7), and subtotal resection (P = 0.006; OR = 9.3) were independent risk factors for postoperative EVD. Tumor infiltrating the ventricular system (P < 0.001; OR = 58.5) and postoperative hemorrhage (P < 0.001; OR = 28.1) were independent risk factors for postoperative VP shunt placement.ConclusionsThese findings may help promote more aggressive monitoring and earlier interventions for postoperative hydrocephalus in patients with PFTs.
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Affiliation(s)
- Chengda Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Neurosurgery, Affiliated Hospital of Hubei University of Medicine, First People’s Hospital of Xiangyang, Xiangyang, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lingli Ge
- Department of Paediatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Central Hospital of Xiangyang, Xiangyang, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Zhengwei Li
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Zhengwei Li
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Masalha W, Heiland DH, Steiert C, Krueger MT, Schnell D, Scheiwe C, Grosu AL, Schnell O, Beck J, Grauvogel J. A Retrospective Evaluation of the Retrosigmoidal Approach for Petroclival Meningioma Surgery and Prognostic Factors Affecting Clinical Outcome. Front Oncol 2022; 12:786909. [PMID: 35433418 PMCID: PMC9010819 DOI: 10.3389/fonc.2022.786909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Petroclival meningioma (PCM) remains a major neurosurgical challenge. There are still controversial strategic treatment concepts about surgical approach, the extent of resection, and postoperative radiotherapy. We aimed to evaluate prognostic factors influencing the progression-free survival (PFS) rates of PCM, with a particular focus on the retrosigmoidal approach, the role of the extent of resection, and postoperative radiotherapy. Methods Eighty-nine patients with complete follow-up data were included. All patients were operated on via a retrosigmoidal approach, of whom 19 underwent gross total resection (GTR) and 70 underwent subtotal resection (STR). In the subgroups of tumors with infiltration of the cavernous sinus, 41 patients received near total resection (NTR) and 24 STR. Thirty-one patients received postoperative radiotherapy of the residual tumor and 58 were treated with surgery alone. Kaplan–Meier analyses and Cox regression were used to identify significant factors associated with treatment. Results GTR (p=0.0107) and postoperative radiotherapy (p=0.014) were associated with significantly improved PFS. Even the subgroup analysis of extended PCM with infiltration of the cavernous sinus (CS) showed an advantage for PFS after near total resection (NTR) (p=0.0017). The additional radiotherapy of the residual tumor in the CS in this subgroup also showed a beneficial effect on PFS (p=0.012). Conclusion The extension of surgical resection remains the most important prognostic factor in relation to oncological outcomes. However, the GTR of extended PCM with infiltration of the CS is associated with significant neurological morbidity and requires additional adjuvant therapy concepts. Postoperative radiotherapy is an important element in the treatment of the residual tumor after surgery.
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Affiliation(s)
- Waseem Masalha
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Waseem Masalha,
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marie T. Krueger
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Schnell
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiation Oncology, Medical Center—University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-L. Grosu
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiation Oncology, Medical Center—University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Beck
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Yoo J, Lim SH, Jung IH, Park HH, Han J, Hong CK. Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas. J Neuroophthalmol 2022; 42:e209-e216. [PMID: 34974485 DOI: 10.1097/wno.0000000000001473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND During the surgical resection of petroclival meningiomas, preserving the cranial nerves is crucial. The abducens nerve is particularly vulnerable during surgery. However, the preoperative risk factors and postoperative prognosis of abducens nerve palsy (ANP) are poorly understood. METHODS We retrospectively analyzed 70 patients who underwent surgery for petroclival meningiomas between May 2010 and December 2019, divided into gross-total resection (GTR) and subtotal resection (STR) groups. The relationship of preoperative clinical factors with the incidence and recovery of postoperative ANP was analyzed. RESULTS Postoperative ANP was observed in 23 patients (32.9%). Multivariable logistic regression revealed that the tumor-to-cerebellar peduncle T2 imaging intensity index (TCTI) (P < 0.001) and internal auditory canal invasion (P = 0.033) contributed to postoperative ANP. GTR was achieved in 37 patients (52.9%), and 10 (27.0%) of them showed ANP. STR was achieved in 33 patients (47.1%), and 13 (39.4%) of them showed ANP. Recovery from ANP took a median of 6.6 months (range, 4.5-20.3 months). At 6 months after the operation, recovery of the abducens nerve function was observed in 16 patients (69.0%); of whom, 4 (40.0%) were in the GTR group and 12 (92.3%) were in the STR group (P = 0.025). CONCLUSIONS TCTI and internal auditory canal invasion were the risk factors for postoperative ANP. Although intentional STR did not prevent ANP immediately after the operation, recovery of the abducens nerve function after surgery was observed more frequently in the STR group than in the GTR group.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery (JY, SHL, IHJ, HHP), Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, Seoul, Korea ; Yonsei University College of Medicine (JY), Seoul, Republic of Korea ; Department of Ophthalmology (JH), Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea ; and Department of Neurosurgery (CKH), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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Barić H, Trkulja V, Peterković V, Mrak G. Mortality and morbidity in surgically treated patients with petroclival meningiomas: a systematic review and meta-analysis of case series. Br J Neurosurg 2022; 36:501-10. [PMID: 35109722 DOI: 10.1080/02688697.2022.2033700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Reports on petroclival meningioma (PCM) surgical mortality and morbidity often deviate from established standards; as such, a comprehensive summary is lacking. METHODS Eligibility/sources. Peer-reviewed case series of at least 10 PCM patients identified from PubMed, Web of Science, Ovid, or Google Scholar. Outcomes. Primary: mortality, tumor recurrence, any cranial nerve deficit (CND); other: individual CNDs, other complications. Data synthesis. Random-effects meta-analysis/meta-regression [effects: surgical approach (supratentorial, S; infratentorial, I; combined, (C), average age and follow-up, sample size, and percent of patients with gross-total resection (GTR)] of logit-transformed proportions. RESULTS Data. 73 case-series/3553 patients. Mortality. Adjusted predicted mortalities of 2.4%, 2.5%, and 1.2% (50-month follow-up) for the S, I, and C approaches, respectively, with the upper limits of the 95% credibility intervals at 3.3%, 3.7%, and 3.6%, respectively. Recurrence. Adjusted predicted recurrences of 5.5%, 11.1%, and 12.0% (50-month follow-up and 57% GTR) for the S, I, and C approaches, respectively; recurrence was positively associated with follow-up period and negatively associated with having received GTR. At all covariates at median values but at GTR 90% predictions: 3.1% (95%CI 3.1-9.8), 6.3% (3.8-10.4), and 6.9% (3.4-13.2) with the S, I, and C; prediction credibility intervals 1-4% and 22.4%. Any CND. Adjusted predicted probabilities of 37.2%, 23.4%, and 29.5% (at median covariate values) for the S, I, and C approaches, respectively; prediction credibility intervals ranged from <10% to 78%. Other outcomes. The most common individual CNDs were nVII (14.4%), nV (11.5%), and nIII (10.2%); other common complications included motor deficit (10.8%), infection (9.8%), and CSF leak (7.5%). CONCLUSION This is the first systematic review on PCM surgical mortality, recurrence, and morbidity. Outcomes differ between surgical approaches and reporting quality varies greatly.
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Affiliation(s)
- Hrvoje Barić
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
| | | | - Goran Mrak
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
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Gao B, Zhang Y, Tan J, Ouyang J, Tai B, Cao X, Li T, Hu S. Surgical Treatment and Clinical Outcomes of Petroclival Meningiomas: A Single-Center Experience of 107 Patients. Front Oncol 2021; 11:761284. [PMID: 34881178 PMCID: PMC8647595 DOI: 10.3389/fonc.2021.761284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to establish optimal surgical strategies via reviewing the clinical outcomes of various surgical approaches for the pertroclival meningiomas (PCMs). Methods This retrospective study enrolled 107 patients with PCMs at the authors’ institution from year 2010 to 2020. Patient demographics, the clinical characteristics, various operative approaches, major morbidity, post-operative cranial nerve deficits and tumor progression or recurrence were analyzed. Results The subtemporal transtentorial approach (STA), the Kawase approach (KA), the retrosigmoid approach (RSA) and the anterior sigmoid approach (ASA), namely the posterior petrosal approach (PPA) were adopted for 17 cases, 22 cases, 31 cases and 34 cases respectively. Total or subtotal resection was achieved in 96 cases (89.7%). The incidence of new-onset and aggravated cranial nerve dysfunction were 13.1% (14/107) and 10.4% (15/144), respectively. Furthermore, 14 cases suffered from intracranial infection, 9 cases had cerebrospinal fluid leakage, and 3 cases sustained intracranial hematoma (1 case underwent second operation). The mean preoperative and postoperative Karnofsky Performance Status (KPS) score was 80 (range 60-100) and 78.6 (range 0-100), but this was not statistically significant (P>0.05). After a mean follow-up of 5.1 years (range 0.3- 10.6 years), tumor progression or recurrence was confirmed in 23 cases. Two cases died from postoperative complications. Conclusions For the treatment of PCMs, it is still a challenge to achieve total resection. With elaborate surgical plans and advanced microsurgical skills, most patients with PCMs can be rendered tumor resection with satisfactory extent and functional preservation, despite transient neurological deterioration during early postoperative periods.
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Affiliation(s)
- Baocheng Gao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yongfa Zhang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jiang Tan
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jinsong Ouyang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Bai Tai
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xianbao Cao
- Department of Ear, Nose and Throat (ENT) and Head and Neck (HN) Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Tao Li
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shuang Hu
- Department of Ear, Nose and Throat (ENT) and Head and Neck (HN) Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Tomio R, Horiguchi T, Borghei-Razavi H, Tamura R, Yoshida K, Kawase T. Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications. J Neurosurg 2021; 136:413-421. [PMID: 34388716 DOI: 10.3171/2020.12.jns204010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anterior transpetrosal approach (ATPA) was initially reported in 1985. The authors' institution has 274 case records of surgery performed with the ATPA during the period from 1984 to 2017. Although many technical advances and modifications in the ATPA have occurred over those 33 years, to the authors' knowledge no articles to date have reported a detailed analysis of variations and complications of the ATPA. In this study, the authors analyzed their patient series to elucidate improvements over time in ATPA methodology while highlighting unresolved problems and evaluating how to avoid surgical complications. METHODS All surgical cases (274 patients) using the ATPA at the authors' institution during the period from 1984 to 2017 were analyzed retrospectively using charts, clinical summaries, operative records, and operative videos. Obtained parameters were patient age and sex, diagnosis, size of tumors, location of disease, operative date, neurological symptoms before and after surgery, radiographically identified brain injury, and other surgical complications. The most common diagnosis was petroclival meningioma (n = 158), followed by trigeminal schwannoma (n = 32), chordoma (n = 25), epidermoid tumor (n = 21), other tumor (n = 27), aneurysm (n = 6), and other (n = 5). RESULTS The original ATPA was performed in 239 cases. In an additional 35 cases, a modified ATPA was performed. Zygomatic osteotomy with ATPA was a common modification that was used in 19 of the 35 cases to decrease retraction damage to the temporal lobe for high-positioned tumors. Brain injury by temporal lobe retraction without venous hemorrhage still occurred in 8 of the 19 cases (3.1%) with surgical death in 1 of these cases (0.4%) of reoperation with sacrifice of the petrosal vein. Symptomatic CSF leak was the most frequent complication noted and was observed in 35 cases (13.5%). In most of these cases the patients were cured by observation or lumbar drain, but in 6 cases (17.1%) reoperation was needed. Facial nerve damage related to surgical approach decreased from 6.2% to 3.5% after 2010; however, the incidence of CSF leaks (13.5%) has not improved. CONCLUSIONS There have been several modifications and advancements made in the ATPA to increase tumor removal and decrease surgical complications. However, complications related to surgical approach occurred, such as venous occlusion-related brain injury and facial nerve damage at pyramid resection. CSF leak remained an unsolved problem related to the ATPA procedures. Preoperative assessment of venous variation of the middle fossa, pneumatization of the temporal bone, and intraoperative monitoring of cranial nerves are important procedures to decrease these complications.
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Affiliation(s)
- Ryosuke Tomio
- 1Department of Neurology and Brain Bank, Mihara Memorial Hospital, Gunma, Japan
| | - Takashi Horiguchi
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Hamid Borghei-Razavi
- 3Department of Neurosurgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida
| | - Ryota Tamura
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Kazunari Yoshida
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Takeshi Kawase
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
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Guinto G, Hernández E, Estrada E, Gallardo D, Kageyama M, Aréchiga N, Guinto-Nishimura GY. Petroclival Meningiomas: A Simple System That Could Help in Selecting the Approach. Oper Neurosurg (Hagerstown) 2021; 21:225-234. [PMID: 34293125 PMCID: PMC8440063 DOI: 10.1093/ons/opab224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Petroclival meningiomas (PCM) represent a neurosurgical challenge due to their strategic location close to the brainstem. OBJECTIVE To assess the applicability of a retrosigmoid approach (RSA) by analyzing the degree of displacement of the middle cerebellar peduncle (MCP) elicited by PCM. METHODS Patients with PCM were prospectively included and divided into those whose imaging studies showed that the posterior end of the MCP was displaced by the tumor and were eligible for and underwent RSA (group A) and those who were not eligible for RSA and who underwent surgery via a posterior transpetrosal approach (group B). We compared tumor behavior, clinical characteristic of patients and surgical results. RESULTS Twenty patients with PCM were enrolled and allocated to group A (n = 15) or group B (n = 5). The clinical manifestations were more severe in group B; tumors in this group were larger and gross total removal was achieved in only 1 patient (20%). In comparison, in 12 cases on group A, tumors could be totally removed (80%) and all of these patients could recover their quality of life after surgery. CONCLUSION To our knowledge, this study is the first to consider displacement of the MCP when establishing a suitable surgical approach for PCM. Our results suggest that the RSA becomes increasingly suitable when peduncle displacement is greater. By using this method, it was also possible to identify two types of tumors: petroclivals (group A) and clivopetrosals (group B), that show some specific clinical and surgical differences.
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Affiliation(s)
- Gerardo Guinto
- Committee of Neurosurgery in the Universidad Nacional Autónoma de México, Mexico City, Mexico.,Centro Médico ABC, Mexico City, Mexico
| | - Eli Hernández
- Hospital Ángeles del Pedregal, Mexico City, Mexico.,Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Eric Estrada
- Department of Neurosurgery, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Mexico City, Mexico
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Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M, Meling TR, Berhouma M, Cossu G, Cornelius JF, Paraskevopoulos D, Zazpe I, Jouanneau E, Cavallo LM, Benes V, Seifert V, Tatagiba M, Schroeder HWS, Goto T, Ohata K, Al-Mefty O, Fukushima T, Messerer M, Daniel RT, Froelich S. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section. Acta Neurochir (Wien) 2021; 163:1639-1663. [PMID: 33740134 DOI: 10.1007/s00701-021-04798-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
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Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - D Starnoni
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - T R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - M Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - G Cossu
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - D Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - I Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - L M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy
| | - V Benes
- Department of Neurosurgery, First Medical Faculty, Military University Hospital and Charles University, Prague, Czech Republic
| | - V Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - H W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - O Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Fukushima
- Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, NC, USA
| | - M Messerer
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
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Ius T, Tel A, Minniti G, Somma T, Solari D, Longhi M, De Bonis P, Scerrati A, Caccese M, Barresi V, Fiorentino A, Gorgoglione L, Lombardi G, Robiony M. Advances in Multidisciplinary Management of Skull Base Meningiomas. Cancers (Basel) 2021; 13:2664. [PMID: 34071391 PMCID: PMC8198762 DOI: 10.3390/cancers13112664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dimensional (3D) preoperative imaging, neuromonitoring, and surgical instruments, have gradually facilitated the surgical resectability of SBMs, reducing postoperative morbidity. Total removal is not always feasible considering a risky tumor location and invasion of surrounding structures and brain parenchyma. In recent years, the use of primary or adjuvant stereotactic radiosurgery (SRS) has progressively increased due to its safety and efficacy in the control of grade I and II meningiomas, especially for small to moderate size lesions. Patients with WHO grade SBMs receiving subtotal surgery can be monitored over time with surveillance imaging. Postoperative management remains highly controversial for grade II meningiomas, and depends on the presence of residual disease, with optional upfront adjuvant radiation therapy or close surveillance imaging in cases with total resection. Adjuvant radiation is strongly recommended in patients with grade III tumors. Although the currently available chemotherapy or targeted therapies available have a low efficacy, the molecular profiling of SBMs has shown genetic alterations that could be potentially targeted with novel tailored treatments. This multidisciplinary review provides an update on the advances in surgical technology, postoperative management and molecular profile of SBMs.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Michele Longhi
- Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata (AOUI), 37128 Verona, Italy;
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Alba Fiorentino
- Radiation Oncology Department, Advance Radiation Therapy, General Regional Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy;
| | - Leonardo Gorgoglione
- Department of Neurosurgery, Hospital “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Massimo Robiony
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
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Kankane VK, Misra BK. Petroclival Meningioma: Management Strategy and Results in 21 st Century. Asian J Neurosurg 2021; 16:89-95. [PMID: 34211873 PMCID: PMC8202385 DOI: 10.4103/ajns.ajns_357_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Petroclival meningioma (PCM) is considered among the most difficult tumors to be treated by microneurosurgery because of its location and its relation to critical structures. The authors report on the outcome in a series of patients with PCM treated in the new millennium with a tailored approach of gross total excision or subtotal removal and adjuvant Gamma Knife Radiosurgery (GKR) depending on the particular case. Methods Between 2001 and 2017, 72 consecutive PCMs were operated in a single center by the senior surgeon. Clinical presentation, operative approaches, intraoperative findings, complications, and imaging findings were retrospectively analyzed. Postoperative outcome, adjuvant Gamma knife, and follow-up findings were reviewed. Results The average age was 47.95 years, and female-to-male ratio was 52:20. Cavernous sinus extension was present in 21 patients. The mean duration of follow-up was 66.65 months. Gross-total resection, near-total resection (NTR), and subtotal resection (STR) resection was achieved in 30, 24, and 18 (42.8%, 34.28%, and 25%) patients, respectively, with recurrences of 10%, 33%, and 50%, respectively. Twenty-two patients (18 STR and 4 NTR) had received postoperative GKR. Only four patients had recurrences following GKR. New cranial nerve deficits were more common in patients in whom a total resection was performed. There was no mortality. Conclusions Gross total excision had the best recurrence free rate though with a higher morbidity. Upfront GKR is advisable in patients with residual tumor, if the preoperative temporal course had a rapid symptomatology, to reduce recurrence. Wait and watch for a small intracavernous residue and radiosurgery on growth is also a valid option as long as follow-up is not suspect. A flexible approach of individualizing the treatment protocol for a given patient goes a long way toward optimal outcome.
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Affiliation(s)
- Vivek Kumar Kankane
- Department of Neurosurgery, G.R. Medical College, JAH Groups of Hospital, Gwalior, Madhya Pradesh, India
| | - Basant Kumar Misra
- Department Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
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Morisako H, Ohata H, Shinde B, Nagahama A, Watanabe Y, Goto T. Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas. J Neurosurg 2021; 135:1180-1189. [PMID: 33607620 DOI: 10.3171/2020.8.jns202060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Petroclival meningiomas (PCMs) remain difficult to remove, and radical tumor resection continues to pose a relatively high risk of neurological morbidity in patients with these lesions because of the proximity of the tumor to neurovascular structures. The anterior and posterior combined (APC) transpetrosal approach allows resection of a large petroclival lesion with minimal retraction of the temporal lobe. However, this approach is thought to be complex and time-consuming. The authors simplified this approach by minimizing the petrosectomy and used this method for large PCMs. This retrospective study describes the surgical technique and surgical outcomes of large PCMs. METHODS Between 2014 and 2019, 23 patients (19 women and 4 men) with benign (WHO grade I) PCMs were treated using the minimal APC (MAPC) transpetrosal approach. The mean age at surgery was 54.0 years (range 37-74 years). The mean tumor diameter was 40.3 mm (range 30-74 mm). The surgical technique consisted of a temporo-suboccipital craniotomy and minimal drilling of the petrous ridge. After opening Meckel's cave and removing the lesion at the prepontine cistern, drilling of the petrous apex with superior mobilization of the trigeminal nerve was performed through the subdural space for further tumor resection around the petrous apex. Finally, the tumor was removed as much as possible. RESULTS The mean preoperative and postoperative tumor volumes were 26.8 and 1.3 cm3, respectively. The mean extent of resection was 95.4% (range 62%-100%). Postoperative impairments included facial numbness in 7 patients, trochlear nerve palsy in 3 patients, mild oculomotor nerve palsy in 2 patients, and transient abducens nerve palsy in 1 patient. Preoperative Karnofsky Performance Status was improved in 13 patients, remained stable in 9 patients, and deteriorated in 1 patient. CONCLUSIONS The MAPC transpetrosal approach provides sufficiently wide exposure of petroclival lesions. Maximal resection via the MAPC transpetrosal approach is a suitable surgical option for the treatment of large PCMs.
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Giammattei L, Starnoni D, Benes V, Froelich S, Cossu G, Borsotti F, Májovsky M, Sufianov AA, Fava A, di Russo P, Elbabaa SK, González-López P, Messerer M, Daniel RT. Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature. World Neurosurg 2021; 147:89-104. [PMID: 33333288 DOI: 10.1016/j.wneu.2020.12.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.
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Affiliation(s)
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Vladimir Benes
- Department of Neurosurgery, Charles University and Military University Hospital, Prague, Czech Republic
| | | | - Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Francois Borsotti
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin Májovsky
- Department of Neurosurgery, Charles University and Military University Hospital, Prague, Czech Republic
| | - Albert A Sufianov
- Department of Neurosurgery, Federal Centre of Neurosurgery, Tyumen, Russia; Department of Neurosurgery, Sechenov University, Moscow, Russia
| | - Arianna Fava
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - Paolo di Russo
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - Samer K Elbabaa
- Department of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Pablo González-López
- Department of Neurosurgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland; Department of Neurosurgery, Sechenov University, Moscow, Russia; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Téllez MJ, Mirallave-Pescador A, Seidel K, Urriza J, Shoakazemi A, Raabe A, Ghatan S, Deletis V, Ulkatan S. Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery. Clin Neurophysiol 2020; 132:622-631. [PMID: 33272821 DOI: 10.1016/j.clinph.2020.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To correlate intraoperative changes of the laryngeal adductor reflex (LAR), alone or in combination with corticobulbar motor evoked potential of vocal muscles (vocal-CoMEPs), with postoperative laryngeal function after posterior fossa and brainstem surgery. METHODS We monitored 53 patients during cerebellar-pontine angle and brainstem surgeries. Vocal-CoMEPs and LAR were recorded from an endotracheal tube with imbedded electrodes or hook-wires electrodes. A LAR significant change (LAR-SC) defined as ≥ 50% amplitude decrement or loss, was classified as either transient or permanent injury to the vagus or medullary pathways by the end of the surgery. RESULTS All patients with permanent LAR loss (n = 5) or LAR-SC (n = 3), developed postoperative laryngeal dysfunction such as aspiration/pneumonia and permanent swallowing deficits (5.6%). Vocal-CoMEP findings refined postoperative vocal motor dysfunction. All seven patients with transient LAR-SC or loss, reverted by changing the surgical approach, did not present permanent deficits. CONCLUSIONS Permanent LAR-SCs or loss correlated with postoperative laryngeal dysfunction and predicted motor and sensory dysfunction of the vagus nerve and reflexive medullary pathways. In contrast, a LAR-SC or loss, averted by a timely surgical adjustment, prevented irreversible damage. SIGNIFICANCE Monitoring of the LAR, with vocal-CoMEPs, may enhance safety to resect complex posterior fossa and brainstem lesions.
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Affiliation(s)
- Maria J Téllez
- Department of Intraoperative Neurophysiology. Mount Sinai West Hospital. New York, NY, USA.
| | - Ana Mirallave-Pescador
- Department of Intraoperative Neurophysiology. Queen's Hospital. Barking, Havering, and Redbridge University Hospitals NHS Trust. London, UK
| | - Kathleen Seidel
- Department of Neurosurgery. Inselspital Bern University Hospital, Bern, Switzerland
| | - Javier Urriza
- Department of Clinical Neurophysiology. Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Alireza Shoakazemi
- Department of Neurosurgery. Queen's Hospital. Barking, Havering, and Redbridge University Hospitals NHS Trust. London, UK
| | - Andreas Raabe
- Department of Neurosurgery. Inselspital Bern University Hospital, Bern, Switzerland
| | - Saadi Ghatan
- Department of Neurosurgery. Mount Sinai West Hospital. New York, NY, USA
| | - Vedran Deletis
- Albert Einstein College of Medicine, New York, NY, USA; Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology. Mount Sinai West Hospital. New York, NY, USA
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Kim JW, Jung HW, Kim YH, Park CK, Chung HT, Paek SH, Kim DG, Lee SH. Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution. J Neurosurg 2020; 132:1675-1682. [DOI: 10.3171/2019.2.jns182604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.
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Affiliation(s)
- Jin Wook Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Hee-Won Jung
- 2Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong Hwy Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Hyun-Tai Chung
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Sun Ha Paek
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Dong Gyu Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Sang Hyung Lee
- 2Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea
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Wang L, Zhang Q, Weng JC, Chen LP, Li D, Jia GJ, Zhang LW, Wu Z, Jia W, Zhang JT. A clinical study of ocular motor nerve functions after petroclival meningioma resection. Acta Neurochir (Wien) 2020; 162:1249-57. [PMID: 32100111 DOI: 10.1007/s00701-020-04262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ocular motor dysfunction is one of the most common postoperative complications of petroclival meningioma. However, its incidence, recovery rate, and independent risk factors remain poorly explored. METHODS A prospective analysis of 31 petroclival meningiomas was performed. Operative approaches were selected by utilizing a new 6-region classification of petroclival meningiomas we proposed. Two scores were used to evaluate the functions of the oculomotor and abducens nerves. Pearson correlation analysis and binary logistic regression analysis were used to identify independent risk factors for intraoperative oculomotor and abducens nerve injury. RESULTS Postoperative new-onset dysfunctions in the pupillary light reflex and eye/eyelid movements as well as abducens paralysis were detected in eight (25.8%), ten (32.3%) and twelve (38.7%) cases, respectively. Their corresponding recovery rates after 6 months of follow-up were 75% (6/8), 80% (8/10), and 83.3% (10/12), respectively, and their mean times to start recovery were 4.03, 2.43, and 2.5 months, respectively. Tumor invasion into the suprasellar region/sphenoid sinus was the only risk factor for dysfunctions in both the pupillary light reflex (p = 0.001) and eye/eyelid movements (p = 0.002). Intraoperative utilization of the infratrigeminal interspace was the only risk factor for dysfunction in eyeball abduction movement (p = 0.004). CONCLUSIONS Dysfunctions of the oculomotor and abducens nerves recovered within 6 months postoperatively. Tumor extension into the suprasellar region/sphenoid sinus was the only risk factor for oculomotor nerve paralysis. Eye/eyelid movements were more sensitive than the pupillary light reflex in reflecting nerve dysfunctions. Intraoperative utilization of the infratrigeminal interspace was the only risk factor for abducens nerve paralysis.
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Affiliation(s)
- Constantin Tuleasca
- 1Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
- 2Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- 3Signal Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- 4Faculté de Médecine, Sorbonne Université, Paris, France
- 5Service de Neurochirurgie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Paris, France
| | - Lorenzo Giammattei
- 1Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Roy Thomas Daniel
- 1Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
- 2Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- 1Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
- 2Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Won SY, Gessler F, Dubinski D, Eibach M, Behmanesh B, Herrmann E, Seifert V, Konczalla J, Tritt S, Senft C. A novel grading system for the prediction of the need for cerebrospinal fluid drainage following posterior fossa tumor surgery. J Neurosurg 2020; 132:296-305. [PMID: 30611134 DOI: 10.3171/2018.8.jns181005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prophylactic placement of an external ventricular drain (EVD) is often performed prior to resection of a posterior fossa tumor (PFT); however, there is no general consensus regarding the indications. The purpose of this study was to establish a novel grading system for the prediction of required CSF drainage due to symptomatic elevated intracranial pressure (ICP) after resection of a PFT to identify patients who require an EVD. METHODS The authors performed a retrospective analysis of data from a prospective database. All patients who had undergone resection of a PFT between 2012 and 2017 at the University Hospital, Goethe University Frankfurt, were identified and data from their cases were analyzed. PFTs were categorized as intraparenchymal (iPFT) or extraparenchymal (ePFT). Prior to resection, patients underwent EVD placement, prophylactic burr hole placement, or neither. The authors assessed the amount of CSF drainage (if applicable), rate of EVD placement at a later time point, and complication rate and screened for factors associated with CSF drainage. By applying those factors, they established a grading system to predict the necessity of CSF drainage for elevated ICP. RESULTS A total of 197 patients met the inclusion criteria. Of these 197, 70.6% received an EVD, 15.7% underwent prophylactic burr hole placement, and 29.4% required temporary CSF drainage. In the prophylactic burr hole group, 1 of 32 patients (3.1%) required EVD placement at a later time. Independent predictors for postoperative need for CSF drainage due to symptomatic intracranial hypertension in patients with iPFTs were preoperative hydrocephalus (OR 2.9) and periventricular CSF capping (OR 2.9), whereas semi-sitting surgical position (OR 0.2) and total resection (OR 0.3) were protective factors. For patients with ePFTs, petroclival/midline tumor location (OR 12.2/OR 5.7), perilesional edema (OR 10.0), and preoperative hydrocephalus (OR 4.0) were independent predictors of need for CSF drainage. According to our grading system, CSF drainage after resection of iPFT or ePFT, respectively, was required in 16.7% and 5.1% of patients with a score of 0, in 21.1% and 12.5% of patients with a score of 1, in 47.1% and 26.3% of patients with a score of 2, and in 100% and 76.5% of patients with a score ≥ 3 (p < 0.0001). The rate of relevant EVD complications was 4.3%, and 10.1% of patients were shunt-dependent at 3-month follow-up. CONCLUSIONS This novel grading system for the prediction of need for CSF drainage following resection of PFT might be of help in deciding in favor of or against prophylactic EVD placement.
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Affiliation(s)
| | | | | | | | | | - Eva Herrmann
- 2Institute of Biostatistics and Mathematical Modeling, Department of Medicine, Frankfurt am Main; and
| | | | | | - Stephanie Tritt
- 3Neuroradiology, University Hospital, Goethe University Frankfurt.,4Department of Radiology, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany
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Zhao Z, Yuan X, Yuan J, Cai L, Jiang W, Xie Y, Wanggou S, Zhang C, Tang G, Li H, Peng Z, Li X, Liu Q. Treatment Strategy for Petroclival Meningiomas Based on a Proposed Classification in a Study of 168 Cases. Sci Rep 2020; 10:4655. [PMID: 32170139 PMCID: PMC7069996 DOI: 10.1038/s41598-020-61497-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/27/2020] [Indexed: 11/11/2022] Open
Abstract
Petroclival meningiomas (PCMs) are regarded as one of the most formidable challenges in neurosurgery. We retrospectively assessed the surgical outcomes of PCMs based on a tumor classification to evaluate the long-term outcomes. A series of 168 patients with PCMs from July 1996 to January 2017. On the basis of the difference in the origin of dural attachment and patterns of growth, the PCMs were classified into 4 different types. The clinical characteristics, surgical record, and follow-up data of each type were reviewed. The study included 138 females (82.1%) with an average age of 49.9 ± 16.2 years. And 138 cases (82.1%) had developed neurological deficits preoperatively with the average tumor size of 44.0 ± 10.6 mm. Specific surgical approaches were applied depended on the tumor classification. Gross total resection (GTR) was achieved in 119 cases (70.8%) with the complications of 46 cases (27.7%). With a median follow-up of 86.5 months, there were 41 cases of recurrence/progress (25.7%) and 39 cases of morbidity (26.4%). Compared with the non-GTR group, the GTR significantly decreased the R/P rate (P = 0.001), prolonged the R/P-FS time (P = 0.032) and improved the follow-up neurological status (P = 0.026). Favorable outcomes and acceptable morbidity were achieved with the treatment strategy of the choice of specific approaches for each type. Meanwhile, the differences of each type in diverse clinical characteristic were verified. Individualized assessment and suitable approach choice should be based on the tumor classification to improved the GTR and quality of life for patients.
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Affiliation(s)
- Zijin Zhao
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Xianrui Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Jian Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Li Cai
- Department of Neurosurgery, The First Affiliated Hospital of University of South China, 69 Chuanshan Road, Hengyang, Hunan, 421000, P R China.,Arkansas Neuroscience Institute, St. Vincent Hospital, 6101 Saint Vincent Cir, Little Rock, Arkansas, AR, 72205, United States
| | - Weixi Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Yuanyang Xie
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Chi Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Guodong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Haoyu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Zefeng Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China
| | - Qing Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China. .,Neurosurgical Institute, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, P R China. .,The Institute of Skull Base Surgery and Neurooncology at Hunan, 87 Xiangya Road, Changsha, Hunan, 410008, P R China.
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Schneider M, Schuss P, Güresir Á, Borger V, Vatter H, Güresir E. Surgery for posterior fossa meningioma: elevated postoperative cranial nerve morbidity discards aggressive tumor resection policy. Neurosurg Rev 2021; 44:953-9. [PMID: 32107680 DOI: 10.1007/s10143-020-01275-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Radical excision of meningioma is suggested to provide for the best tumor control rates. However, aggressive surgery for meningiomas located at the posterior cranial fossa may lead to elevated postoperative morbidity of adjacent cranial nerves which in turn worsens patients' postoperative quality of life. Therefore, we analyzed our institutional database with regard to new cranial nerve dysfunction as well as postoperative cerebrospinal fluid (CSF) leakage depending on the extent of tumor resection. Between 2009 and 2017, 89 patients were surgically treated for posterior fossa meningioma at the authors' institution. Postoperative new cranial nerve dysfunction as well as CSF leakage were stratified into Simpson grade I resections with excision of the adjacent dura as an aggressive resection regime versus Simpson grade II-IV tumor removal. Simpson grade I resections revealed a significantly higher percentage of new cranial nerve dysfunction immediately after surgery (39%) compared with Simpson grade II (11%, p = 0.01) and Simpson grade II-IV resections (14%, p = 0.02). These observed differences were also present for the 12-month follow-up (27% Simpson grade I, 3% Simpson grade II (p = 0.004), 7% Simpson grades II-IV (p = 0.01)). Postoperative CSF leakage was present in 21% of Simpson grade I and 3% of Simpson grade II resections (p = 0.04). Retreatment rates did not significantly differ between these two groups (6% versus 8% (p = 1.0)). Elevated levels of postoperative new cranial nerve deficits as well as CSF leakage following radical tumor removal strongly suggest a less aggressive resection policy to constitute the surgical modality of choice for posterior cranial fossa meningiomas.
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Shimanskiy VN, Karnaukhov VV, Galkin MV, Tanyashin SV, Golanov AV, Poshataev VK, Shevchenko KV. [Treatment of petroclival meningiomas: current state of the problem]. Zh Vopr Neirokhir Im N N Burdenko 2020; 83:78-89. [PMID: 32031171 DOI: 10.17116/neiro20198306178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.
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Affiliation(s)
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Abstract
The incidence of meningiomas is rising and the number of incidental cases is increasing steadily. The efficiency and the safety of each treatment strategy are also improving over time. Therefore the indications to treat meningiomas are constantly changing. The aim of meningioma treatment is keeping the patient fully functional while achieving long-term relief or prevention from problems related to intracranial tumor growth. This chapter reviews the natural history and treatment results and aims to put together the information for the most objective decision-making in treating meningiomas. Factors acting on the treatment decision such as anatomical localization, symptomatology, variations in tumor biology, recurrence status, age and co-morbidities, operative gains, and patient preference are individually discussed.
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Affiliation(s)
- M Necmettin Pamir
- Department of Neurosurgery, Acıbadem University, School of Medicine, Istanbul, Turkey.
| | - Koray Özduman
- Department of Neurosurgery, Acıbadem University, School of Medicine, Istanbul, Turkey
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Abstract
As with other meningiomas, the goal of petroclival meningioma treatment should be curative total removal by achieving a Simpson I resection of the tumor, dura, and bone. Petroclival meningiomas particularly pose a great technical challenge because of their deep location and intimate relation with vital neurovascular structures. They require adequate exposure and trajectory to achieve total removal while minimizing the manipulation and risk to critical neurovascular structures, such as the vertebrobasilar system, the brainstem, and the cranial nerves. Here, we describe the indications and technical nuances of the posterior and combined posterior-anterior petrosal approaches for petroclival meningiomas.
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Affiliation(s)
- David Aum
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marcio S Rassi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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Martínez-Pérez R, Silveira-Bertazzo G, Rangel GG, Albiña P, Hardesty D, Carrau RL, Prevedello DM. The historical perspective in approaches to the spheno-petro-clival meningiomas. Neurosurg Rev 2019; 44:51-60. [PMID: 31802287 DOI: 10.1007/s10143-019-01197-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/20/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
The current literature regarding surgical treatment for tumors in the sphenopetroclival (SPC) region is merely scarce. Through a comprehensive literature review, we investigated the indications, outcomes, and complications of different surgical approaches to the SPC meningiomas. Given its complicated relationship between these slow-progression tumors and some critical neurovascular structures in the SPC region, surgical treatment of these tumors faces the challenge of achieving a maximal grade of resection, while preserving patient functionality. The development of new surgical techniques and approaches in recent years have permitted the advancement in the treatment of these tumors, with acceptable rates of morbidity and mortality. The choice of a surgical approach as a treatment for the lesion depends mainly on the type of tumor extension, surgeon's preferences, and the displacement of neurovascular structures. Rather than focusing on one single strategy of treatment, the skull-base surgeon should tailor the approach based on the origin and features of the lesion; as well as the peculiarities of the surgical anatomy. This strategy aims to decrease morbidity and to optimize tumor resection and patient quality of life.
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Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.
| | - Giuliano Silveira-Bertazzo
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA
| | - Gustavo G Rangel
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Pablo Albiña
- Department of Neurosurgery, Hospital Barros Luco, Universidad de Santiago de Chile, Santiago, Chile
| | - Douglas Hardesty
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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Hunter JB, O'Connell BP, Carlson ML, Chambless LC, Yawn RJ, Wang R, Mistry A, Thompson RC, Weaver KD, Wanna GB. Tumor Progression Following Petroclival Meningioma Subtotal Resection: A Volumetric Study. Oper Neurosurg (Hagerstown) 2019; 14:215-223. [PMID: 28541487 DOI: 10.1093/ons/opx098] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One study has investigated postoperative growth rates following subtotal resection of petroclival meningiomas utilizing linear measurements, which are insensitive to the multidimensional complex growth of meningiomas, to estimate tumor volume. OBJECTIVE To describe petroclival meningioma growth patterns following less-than-complete resection utilizing volumetric analysis and to identify variables associated with tumor progression. METHODS Patients with surgically resected WHO grade I petroclival meningiomas were retrospectively reviewed (1999-2015). Image analysis software was utilized to perform volumetric analyses of tumor size and growth on serial MRI studies. The impact of preoperative and postoperative variables on tumor growth after subtotal resection was analyzed. An increase in tumor volume of at least 20% was defined as "tumor growth." RESULTS Twenty-three patients had immediate preoperative and serial postoperative MRI studies available for review. The mean preoperative tumor volume was 20.9 cm3 (range 0.4-54.6). The mean extent of resection was 75.5% (range 31.5%-100.0%). At a mean follow-up of 24.8 mo, 12 tumors (66.7%) exhibited radiological tumor growth, while 6 tumors did not change in size. The median annual volumetric growth rate was 2.82 cm3/yr (range -0.34 to 10.1). Extent of resection and immediate postoperative tumor volume were significantly correlated with the annual volumetric growth rate following resection. At last follow-up, 3 (13%) patients required further intervention. CONCLUSION The majority of petroclival meningiomas exhibit growth following subtotal resection. Extent of resection is strongly associated with risk for disease progression following surgery.
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Affiliation(s)
- Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Roch-ester, Minnesota
| | - Lola C Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Yawn
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ray Wang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Akshitkumar Mistry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reid C Thompson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle D Weaver
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Magill ST, Lee DS, Yen AJ, Lucas CHG, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical outcomes after reoperation for recurrent skull base meningiomas. J Neurosurg 2019; 130:876-883. [PMID: 29726777 DOI: 10.3171/2017.11.jns172278] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Skull base meningiomas are surgically challenging tumors due to the intricate skull base anatomy and the proximity of cranial nerves and critical cerebral vasculature. Many studies have reported outcomes after primary resection of skull base meningiomas; however, little is known about outcomes after reoperation for recurrent skull base meningiomas. Since reoperation is one treatment option for patients with recurrent meningioma, the authors sought to define the risk profile for reoperation of skull base meningiomas. METHODS A retrospective review of 2120 patients who underwent resection of meningiomas between 1985 and 2016 was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningiomas were reviewed. Demographic data, presenting symptoms, surgical management, outcomes, and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications. RESULTS Seventy-eight patients underwent 100 reoperations for recurrent skull base meningiomas. Seventeen patients had 2 reoperations, 3 had 3 reoperations, and 2 had 4 or more reoperations. The median age at diagnosis was 52 years, and 64% of patients were female. The median follow-up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis, and weakness. The median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO grade I, 22% were WHO grade II, and 6% were WHO grade III. The sphenoid wing was the most common location (31%), followed by cerebellopontine angle (14%), cavernous sinus (13%), olfactory groove (12%), tuberculum sellae (12%), and middle fossa floor (5%). Forty-four (54%) tumors were ≥ 3 cm in maximum diameter at the time of the first reoperation. In 100 reoperations, 60 complications occurred in 30 cases. Twenty of the 60 complications required surgical intervention (33%). Complications included hydrocephalus (12), CSF leak/pseudomeningocele (11), wound infection (9), postoperative hematoma (4), venous infarction (1), and pneumocephalus (1). Postoperative neurological deficits included new or worsened cranial nerve deficits (10) and hemiparesis (3). There were no perioperative deaths in this series. On multivariate analysis, posterior fossa location was significantly associated with complications (OR 3.45, p = 0.0472). The 1-, 2-, 5-, and 10-year overall survival rates according to Kaplan-Meier analysis after the first reoperation were 94%, 92%, 88%, and 76%, respectively. The median survival after the first reoperation was 17 years. CONCLUSIONS Recurrent skull base meningiomas are surgically challenging tumors, and reoperation is associated with high morbidity and complication rates. Despite these cautionary data, repeat resection of recurrent skull base meningiomas in appropriately selected patients provides excellent long-term survival.
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Affiliation(s)
| | | | | | | | - David R Raleigh
- 2Radiation Oncology, University of California, San Francisco, California
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Ressel A, Fichte S, Brodhun M, Rosahl SK, Gerlach R. WHO grade of intracranial meningiomas differs with respect to patient’s age, location, tumor size and peritumoral edema. J Neurooncol 2019; 145:277-86. [DOI: 10.1007/s11060-019-03293-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022]
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Abstract
PURPOSE OF REVIEW This review presents the most recent evidences and recommendations in the pre-, intra-, and post-surgical management of patients harboring meningiomas. Due to the increasing relevance of multimodal approaches, in order to preserve patients' neurological function and quality of life (QoL), the role of observation and radiation treatments (as either primary or adjuvant therapy) has also been discussed. RECENT FINDINGS Multiple advances in neurosurgery, including the use of the microscope and endoscope, improved preoperative neuroimaging, intraoperative image-guided approaches, and intraoperative neurophysiological monitoring, have extended the neurosurgeon's ability to remove lesions that were previously considered only partially resectable or unresectable, while minimizing morbidity. On the other hand, the preservation of patients' neurological integrity and QoL are increasingly important issues, more than complete tumor resection, for both patients and neurosurgeons. In this setting, stereotactic radiosurgery (SRS) and radiotherapy (RT) may be considered safe and effective alternatives for asymptomatic small- to moderate-sized tumors that demonstrate growth on serial imaging, or in combination with planned subtotal resection (STR) for tumors in critical locations. Data supporting the use of pharmacotherapy in meningiomas are, to date, weak, but the strength of the evidence might improve in the next future with the identification of targetable mutations. Complete microsurgical resection remains the standard of care if it can be achieved with minimal or no morbidity. However, many studies have reported SRS/RT as safe and effective treatments, either as primary approach or as complementary to surgery, especially when dealing with critically located meningiomas (e.g., cranial base) or in patients with comorbidity or wishing to avoid invasive treatments. The management of meningiomas is a field of complementary disciplines: neurosurgeon needs to work closely with radiation oncologists while tailoring the optimal treatment for these patients in order to achieve the best results.
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Affiliation(s)
- Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Sahlu A, Laeke T, Kassahun A, Tirsit A, Debebe T, Gemechu T, Lund-johansen M. One Hundred Skull Base Meningiomas Operated at Black Lion Specialized Hospital, Addis Ababa, Ethiopia. World Neurosurg 2019; 126:e1321-9. [DOI: 10.1016/j.wneu.2019.03.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/18/2022]
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Bernard F, Troude L, Isnard S, Lemée JM, Terrier LM, François P, Velut S, Gay E, Fournier HD, Roche PH. Long term surgical results of 154 petroclival meningiomas: A retrospective multicenter study. Neurochirurgie 2019; 65:55-62. [PMID: 31104846 DOI: 10.1016/j.neuchi.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.
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Affiliation(s)
- F Bernard
- Department of Neurosurgery, CHU Anger, 49100 Angers, France.
| | - L Troude
- Department of Neurosurgery, CHU APHM-Hopital Nord, 13015 Marseille, France.
| | - S Isnard
- Department of Neurosurgery, CHRU de Grenoble, 38000 Grenoble, France.
| | - J-M Lemée
- Department of Neurosurgery, CHU Anger, 49100 Angers, France.
| | - L M Terrier
- Department of Neurosurgery, CHRU de Tours, 37044 Tours, France.
| | - P François
- Department of Neurosurgery, CHRU de Tours, 37044 Tours, France.
| | - S Velut
- Department of Neurosurgery, CHRU de Tours, 37044 Tours, France.
| | - E Gay
- Department of Neurosurgery, CHRU de Grenoble, 38000 Grenoble, France.
| | - H-D Fournier
- Department of Neurosurgery, CHU Anger, 49100 Angers, France.
| | - P-H Roche
- Department of Neurosurgery, CHU APHM-Hopital Nord, 13015 Marseille, France.
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Schneider M, Schuss P, Güresir Á, Wach J, Hamed M, Vatter H, Güresir E. Cranial Nerve Outcomes After Surgery for Frontal Skull Base Meningiomas: The Eternal Quest of the Maximum-Safe Resection with the Lowest Morbidity. World Neurosurg 2019; 125:e790-e796. [PMID: 30738945 DOI: 10.1016/j.wneu.2019.01.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Maximal aggressive meningioma resection has been suggested to provide the best tumor control rates. However, radical surgery of meningiomas located at the frontal skull base can be accompanied by impairment of adjacent cranial nerve function that negatively affects patients' quality of life. We, therefore, analyzed our institutional database for cases of new cranial nerve deficits and postoperative cerebrospinal fluid (CSF) leakage stratified by the extent of tumor resection. METHODS From February 2009 to April 2017, 195 patients underwent resection of frontal skull base meningioma at our institution. Postoperative new deficits of cranial nerve function and CSF leakage were stratified by the resection into Simpson grade I resection with excision of the dural tail as an aggressive surgical approach and Simpson grade II-V resection. RESULTS Simpson grade I resection was associated with a significantly greater percentage of new cranial nerve deficits immediately after surgery (30%) compared with Simpson grade II (13%; P = 0.007) and Simpson grade II-V (17%; P = 0.035). The differences were greater at the 12-month follow-up point (29% Simpson grade I, 6% Simpson grade II [P < 0.001]; 10% Simpson grade II-V [P = 0.001]). Postoperative CSF leakage occurred in 10.1% of Simpson grade I versus 2.3% of Simpson grade II resections (P = 0.048). The retreatment rates did not differ between these 2 groups (2.5% vs. 3.4%; P = 1.000). CONCLUSIONS We found high levels of new cranial nerve morbidity and CSF leakage after radical removal of frontal skull base meningiomas that included the adjacent dura. Thus, less aggressive surgery for frontobasal meningioma should be preferred.
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Affiliation(s)
- Matthias Schneider
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
| | - Patrick Schuss
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ági Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Johannes Wach
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
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Lynch JC, Pereira C, Welling L, Gonçalves M, Zanon N. Extended Retrosigmoid Approach for Cerebellopontine Angle Meningiomas: Operative Technique and Results-A Series of 28 Patients. Skull Base Surg 2018; 79:458-465. [PMID: 30210973 DOI: 10.1055/s-0037-1620278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
Background The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). Methods We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. Results The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). Conclusion The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cranial base approaches.
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Affiliation(s)
- Jose Carlos Lynch
- Department of Neurosurgery, Public Servants Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celestino Pereira
- Department of Neurosurgery, Public Servants Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Welling
- Department of Neurosurgery, Universidade Estadual de Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Nelci Zanon
- Department of Neurosurgery, Public Servants Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
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Tomasello F, Angileri FF, Conti A, Scibilia A, Cardali S, La Torre D, Germanò A. Petrosal Meningiomas: Factors Affecting Outcome and the Role of Intraoperative Multimodal Assistance to Microsurgery. Neurosurgery 2018; 84:1313-1324. [DOI: 10.1093/neuros/nyy188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
- Depart-ment of Neurosurgery, Charité Univer-sitätsmedizin, Berlin, Germany
| | | | | | | | - Antonino Germanò
- Department of Neurosurgery, University of Messina, Messina, Italy
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Pintea B, Kandenwein J, Lorenzen H, Boström J, Daher F, Velazquez V, Kristof R. Factors of influence upon the SF-36-based health related quality of life of patients following surgery for petroclival and lateral posterior surface of pyramid meningiomas. Clin Neurol Neurosurg 2018; 166:36-43. [DOI: 10.1016/j.clineuro.2018.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/07/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
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Isolan GR, Wayhs SY, Lepski GA, Dini LI, Lavinsky J. Petroclival Meningiomas: Factors Determining the Choice of Approach. J Neurol Surg B Skull Base 2017; 79:367-378. [PMID: 30009118 DOI: 10.1055/s-0037-1608654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Design Retrospective review. Setting The study was conducted in a university hospital in southern Brazil. Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6-75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.
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Affiliation(s)
- Gustavo Rassier Isolan
- Graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS); Neurotology and Acoustic Neuroma Center (CNNA); Clínica Lavinsky; Hospital Moinhos de Vento - Porto Alegre, Rio Grande do Sul, Brazil.,The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sâmia Yasin Wayhs
- Graduate Program in Medicine: Surgical Sciences, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Alves Lepski
- Department of Neurology, Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Leandro Infantini Dini
- The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
| | - Joel Lavinsky
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,CNNA; Clínica Lavinsky, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract
Surgery plays an important role in the management of high-grade gliomas (HGG) and imparts significant tumor-free and overall survival advantages. However HGG margins are often invisible, making their gross total resection (GTR) a difficult task. Hence intraoperative technology such as intraoperative fluorescence was a revolutionary discovery. A critical literature review revealed fluorescence improved the GTR of HGG from 36% using standard surgery to 74.5 and 84.4% using aminolevulinic acid (ALA) or fluorescein (FLCN), respectively. The differences between ALA-fluorescence image-guided neurosurgery (FIGS) and FLCN-FIGS in HGG were not statistically significant. However, the cost per quality added life years was US$16,218 and US$3181 for ALA-FIGS and FLCN-FIGS, respectively. Therefore, FIGS provided a reliable intraoperative tumor marker. Both ALA- and FLCN-FIGS significantly improved GTR and were cost-effective.
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Affiliation(s)
- Sadao Kaneko
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, No. 7-20, 15-chome, 1-jyou, Tsukisamuhigashi, Toyohira-ku, Sapporo, Hokkaido 062-5813, Japan
| | - Muftah S Eljamel
- Neurosciences, HTNMS, 20/22 Torphichen Street, Edinburgh, EH3 8JB, UK
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Kim JW, Kim DG, Se YB, Kim SK, Chung HT, Paek SH, Jung HW. Gamma Knife Radiosurgery for Petroclival Meningioma: Long-Term Outcome and Failure Pattern. Stereotact Funct Neurosurg 2017; 95:209-215. [PMID: 28683438 DOI: 10.1159/000475763] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
Total removal of petroclival meningioma is difficult, and aggressive extirpation is often associated with significant surgical morbidity and mortality. The aim of this study was to evaluate the long-term outcome and failure pattern of treatment with Gamma Knife radiosurgery (GKRS) in patients with petroclival meningiomas. Eighty-nine consecutive patients with petroclival meningiomas underwent GKRS between 1998 and 2013. Fifty-eight patients received GKRS as a primary treatment and 31 patients underwent GKRS as a secondary treatment after microsurgery. The mean tumor volume was 6.7 cm3 (range, 0.5-46.3 cm3) and the mean marginal dose was 13.2 Gy (range, 8-17 Gy). At the last radiological follow-up, tumor volume was decreased in 50 patients (56.2%), stationary in 34 patients (38.2%), and increased in 5 patients (5.6%). The actuarial progression-free survival after GKRS was 94.7% at 5 years and 88.9% at 10 years. Favorable cranial nerve outcomes were found in 81 patients (91%). A regrowth pattern was present in all 4 patients of the primary treatment group, whereas cyst formation (3 patients) and regrowth (1 patient) were observed in the secondary treatment group. GKRS is an effective and reasonable option as a primary or secondary treatment for petroclival meningioma. Further studies of failure patterns after GKRS for petroclival meningioma are mandatory.
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Affiliation(s)
- Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
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