Patients??? Outcome at Long-term Follow-up after Aggressive Microsurgical Resection of Petroclival Meningiomas

Abstract OBJECTIVE: To evaluate patient clinical outcome and survival at long-term follow-up after aggressive microsurgical resection of chondrosarcomas of the cranial base. METHODS: Over a 20-year period, 47 patients underwent 72 operative procedures for resection of cranial base chondrosarcomas. Thirty-three patients were previously untreated, whereas 14 patients previously had undergone surgery or radiation. Twenty-three patients had a single operation and 24 underwent staged (more than one) operations because of extensive disease. Patients who underwent subtotal resection also underwent radiotherapy or radiosurgery. Patients were evaluated at follow-up clinically and by imaging studies. RESULTS: Gross total resection was accomplished in 29 (61.7%) patients, and subtotal resection was accomplished in 18 patients (38.3%). The resection was better in patients who underwent a primary operation (gross total resection, 68.8 versus 46.7%) rather than a reoperation. Patients who underwent incomplete resection underwent postoperative radiotherapy, which included proton beam radiotherapy (15.6%), radiosurgery (68%), and fractionated radiation (15.6%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 10 patients (18%). The follow-up ranged from 2 to 255 months, with an average of 86 months. At the conclusion of study, 36 (76.6%) patients were alive, and 21 (44.7%) patients were alive without disease. Recurrence-free survival was 32% at 10 years in all patients, 42.3% in primary patients and 13.8% in those who underwent reoperation. The Karnofsky performance score was 82.4 ± 9.8 before surgery, 85 ± 12.5 at 1 year after surgery, and 85.3 ± 5.8 at the latest follow-up. Two patients died as a result of radiotherapy complications (malignancy, radiation necrosis). CONCLUSION: Cranial base chondrosarcomas can be managed well by complete surgical resection or by a combination of surgery and radiotherapy. The study cannot comment about the efficacy of radiotherapy. Approximately half of the patients survived without recurrence at long-term follow-up (>132 mo). The functional status of the surviving patients was excellent at follow-up.

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Pineocytomas: a long-term follow up study of four cases in Helsinki Neurosurgery

Journal of Case Reports in Medicine ◽

10.25149/case-reports.v8i1.162 ◽

2019 ◽

Vol 8 (1) ◽

pp. 5

Author(s):

Joham Choque-Velasquez ◽

Julio C Resendiz-Nieves ◽

Behnam Rezai Jahromi ◽

Roberto Colasanti ◽

Rahul Raj ◽

...

Keyword(s):

Good Prognosis ◽

Gross Total Resection ◽

Benign Lesions ◽

Total Resection ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up ◽

Microsurgical Resection

Background: Pineocytomas are rare benign lesions with a relatively good prognosis if gross total resection can be achieved. Report of cases: We present a retrospective review of four patients with histologically confirmed pineocytomas consecutively operated on after 1997. All of our patients were alive at a mean follow-up of 224,5 months (range 204-246). A gross total resection was accomplished in all cases. The cornerstones for the surgical resection of pineocytomas are reported. Conclusions: A proper management of pineocytomas, based on the gross total microsurgical resection of the lesion, results in an excellent long term outcome of these pineal lesions.

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PETROCLIVAL MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000255472.52882.d6 ◽

2007 ◽

Vol 60 (6) ◽

pp. 965-981 ◽

Cited By ~ 101

Author(s):

Sabareesh K. Natarajan ◽

Laligam N. Sekhar ◽

David Schessel ◽

Akio Morita

Keyword(s):

Survival Rate ◽

Gamma Knife ◽

Cranial Nerve ◽

Tumor Resection ◽

Gamma Knife Radiosurgery ◽

Free Survival ◽

Petroclival Meningiomas ◽

Long Term Follow Up

Abstract OBJECTIVE To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclivaTl meningiomas. METHODS During a 13-year period (1991–2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images. RESULTS At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15–180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 ± 11 preoperatively, 76 ± 11 at 1 year postoperatively, and 84 ± 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms. CONCLUSION This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.

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Long-Term Follow-Up of Petroclival Meningiomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1314207 ◽

2012 ◽

Vol 73 (S 02) ◽

Author(s):

K. Saito ◽

T. Horiguchi ◽

S. Ichimura ◽

S. Ohba ◽

T. Kawase ◽

...

Keyword(s):

Petroclival Meningiomas ◽

Long Term Follow Up

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Surgical management of medium and large petroclival meningiomas: a single institution’s experience of 199 cases with long-term follow-up

Acta Neurochirurgica ◽

10.1007/s00701-015-2671-6 ◽

2016 ◽

Vol 158 (3) ◽

pp. 409-425 ◽

Cited By ~ 12

Author(s):

Da Li ◽

Jie Tang ◽

Cong Ren ◽

Zhen Wu ◽

Li-Wei Zhang ◽

...

Keyword(s):

Surgical Management ◽

Petroclival Meningiomas ◽

Long Term Follow Up

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Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma

Journal of Neurosurgery ◽

10.3171/2016.11.jns16498 ◽

2020 ◽

Vol 133 (4) ◽

pp. 1052-1058 ◽

Cited By ~ 20

Author(s):

Hirofumi Nakatomi ◽

Jeffrey T. Jacob ◽

Matthew L. Carlson ◽

Shota Tanaka ◽

Minoru Tanaka ◽

...

Keyword(s):

At Risk ◽

Survival Rates ◽

Subtotal Resection ◽

Recurrence Free Survival ◽

Free Survival ◽

Risk Of Recurrence ◽

Long Term Follow Up ◽

Microsurgical Resection

OBJECTIVEThe management of vestibular schwannoma (VS) remains controversial. One commonly cited advantage of microsurgery over other treatment modalities is that tumor removal provides the greatest chance of long-term cure. However, there are very few publications with long-term follow-up to support this assertion. The purpose of the current study is to report the very long-term risk of recurrence among a large historical cohort of patients who underwent microsurgical resection.METHODSThe authors retrospectively reviewed the medical records of patients who had undergone primary microsurgical resection of unilateral VS via a retrosigmoid approach performed by a single neurosurgeon-neurotologist team between January 1980 and December 1999. Complete tumor removal was designated gross-total resection (GTR), and anything less than complete removal was designated subtotal resection (STR). The primary end point was radiological recurrence-free survival. Time-to-event analyses were performed to identify factors associated with recurrence.RESULTSFour hundred fourteen patients met the study inclusion criteria and were analyzed. Overall, 67 patients experienced recurrence at a median of 6.9 years following resection (IQR 3.9–12.1, range 1.2–22.5 years). Estimated recurrence-free survival rates at 5, 10, 15, and 20 years following resection were 93% (95% CI 91–96, 248 patients still at risk), 78% (72–85, 88), 68% (60–77, 47), and 51% (41–64, 22), respectively. The strongest predictor of recurrence was extent of resection, with patients who underwent STR having a nearly 11-fold greater risk of recurrence than the patients treated with GTR (HR 10.55, p < 0.001). Among the 18 patients treated with STR, 15 experienced recurrence at a median of 2.7 years following resection (IQR 1.9–8.9, range 1.2–18.7). Estimated recurrence-free survival rates at 5, 10, 15, and 20 years following GTR were 96% (95% CI 93–98, 241 patients still at risk), 82% (77–89, 86), 73% (65–81, 46), and 56% (45–70, 22), respectively. Estimated recurrence-free survival rates at 5, 10, and 15 years following STR were 47% (95% CI 28–78, 7 patients still at risk), 17% (5–55, 2), and 8% (1–52, 1), respectively.CONCLUSIONSLong-term surveillance is required following microsurgical resection of VS even after GTR. Subtotal resection alone should not be considered a definitive long-term cure. These data emphasize the importance of long-term follow-up when reporting tumor control outcomes for VS.

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Patient Outcome at Long-term Follow-up after Aggressive Microsurgical Resection of Cranial Base Chordomas

Neurosurgery ◽

10.1227/01.neu.0000223441.51012.9d ◽

2006 ◽

Vol 59 (2) ◽

pp. 230-237 ◽

Cited By ~ 166

Author(s):

Fortios Tzortzidis ◽

Foad Elahi ◽

Donald Wright ◽

Sabareesh K. Natarajan ◽

Laligam N. Sekhar

Keyword(s):

Scale Score ◽

Cranial Base ◽

Karnofsky Performance Scale ◽

Free Survival ◽

Long Term Follow Up ◽

Microsurgical Resection ◽

Karnofsky Performance Scale Score ◽

Performance Scale

Abstract OBJECTIVE: In this study, we evaluated patients' clinical outcome and recurrence rates at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. METHODS: Seventy-four patients with chordomas underwent operations during a 16-year period from 1988 to 2004. The philosophy was to perform complete resection whenever possible and to provide adjuvant radiotherapy for remnants. Staged operations were performed for extensive tumors or if a sizable tumor remnant was noted after the first resection. Patients included primary (previously untreated) and previously operated or irradiated cases. Information was prospectively gathered concerning the patients' neurological condition, Karnofsky Performance Scale score, and tumor status on magnetic resonance imaging scans. RESULTS: There were 47 primarily operated patients (63.5%) and 27 patients (36.5%) who had previously undergone surgery or radiotherapy. A total of 121 procedures were performed in 74 patients. The mean follow-up period was 96 months, with a range of 1 to 198 months. A single stage removal was performed in 41 (55.4%) of the patients and multiple stage removal was performed in 33 (44.5%) of the patients. Gross total removal was accomplished in 53 (71.6%) of the patients, and subtotal resection was accomplished in 21 (28.4%) of the patients. During the follow-up period, 24 (32%) of the patients had no evidence of disease, 37 (50%) of the patients were alive with evidence of disease, 11 (14.8%) of the patients died of disease, and two (2.7%) of the patients died of complications. Recurrence-free survival at 10 years was 31% for the whole group, 42% for the primarily operated patients, and 26% for the reoperation cases (P = 0.0001). The average Karnofsky Performance Scale score was 80 ± 11.7 preoperatively, 84 ± 8.9 at the 1-year follow-up, and 86 ± 12.8 at the last follow-up in surviving patients. No conclusion could be drawn regarding the value of radiotherapy because of the treatment philosophy and the small number of patients. CONCLUSION: Aggressive microsurgical resection of chordomas can be followed by long-term, tumor-free survival with good functional outcome. A more conservative strategy is recommended in reoperation cases, especially after previous radiotherapy, to reduce postoperative complications.

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