Surgical Treatment and Clinical Outcomes of Petroclival Meningiomas: A Single-Center Experience of 107 Patients

ObjectiveThis study aimed to establish optimal surgical strategies via reviewing the clinical outcomes of various surgical approaches for the pertroclival meningiomas (PCMs).MethodsThis 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.ResultsThe 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.ConclusionsFor 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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Surgery of petroclival meningiomas. Recent surgical results and outcomes

Romanian Neurosurgery ◽

10.1515/romneu-2015-0003 ◽

2015 ◽

Vol 22 (1) ◽

pp. 27-37

Author(s):

Mugurel Radoi ◽

Florin Stefanescu ◽

Ram Vakilnejad ◽

Lidia Gheorghitescu ◽

Daniela Rosu

Keyword(s):

Tumor Resection ◽

Cranial Nerves ◽

Surgical Approaches ◽

Subtotal Resection ◽

Recent Experience ◽

Surgical Results ◽

Petroclival Meningiomas ◽

Microsurgical Techniques ◽

Postoperative Hydrocephalus ◽

Loss Of Hearing

Abstract Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. We described our recent experience (2005-September2014) regarding the surgery of these tumors. We retrospectively analyzed surgical results and outcome in 11 cases of petroclival meningiomas. Most common symptoms in our series were headache and gait disturbance, while cranial nerves palsies represented the most common presenting signs. There were 8 females and 3 males, and the mean age was 52 years. Surgical approaches chosen for petroclival meningiomas in our series were retrosigmoid (9 patients) and subtemporal transtentorial (2 patients). We achieved total tumor resection in 5 cases (45%) and subtotal resection in 6 cases (55%). Overall outcome (total/subtotal resection) was good in 6 cases, fair in 3 cases and poor in one case. One postoperative death occurred due to hemorrhagic midbrain infarction (9%). Complications were usually related to cranial nerve deficits: loss of hearing (2 patients), paresis of trochlear nerve (1 patient), trigeminal nerve (3 patients) and facial nerve (1 patient). In 4 patients these cranial nerves deficits were transient. In one case, a patient developed postoperative hydrocephalus and needed shunt placement. Despite the fact that complications can be disastrous, we considered that an appropriate approach, combined with microsurgical techniques and a better understanding of the anatomy, greatly decrease the incidence and severity of complications and make feasible a total tumor resection.

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Skull-Base Surgery: Operative Refinements

Otolaryngology ◽

10.1177/019459988609400310 ◽

1986 ◽

Vol 94 (3) ◽

pp. 315-321 ◽

Cited By ~ 13

Author(s):

Aina J. Gulya ◽

Michael E. Glasscock ◽

C. Gary Jackson ◽

Myles L. Pensak ◽

Perry F. Harris ◽

...

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Postoperative Morbidity ◽

Operative Procedure ◽

Muscle Flap ◽

Surgical Approaches ◽

Cerebrospinal Fluid Leakage ◽

Cranial Nerve Dysfunction ◽

Skull Base Lesions ◽

Flap Closure

Advances in microsurgical techniques, with the use of the laser and the ultrasonic suction aspirator, have paved the way for even more aggressive surgical approaches to large skull-base lesions, such as glomus tumors, adenocarcinomas of the temporal bone, and cranial nerve neuromas. Postoperative morbidity of multiple cranial nerve dysfunction has been aggravated in the past by cerebrospinal fluid leakage and/or gastro-intestinal dysfunction. At the Otology Group, P.C., In the course of dealing with more than 86 skull-base tumors, we have developed a standardized, multispecialty approach to such extensive skull-base lesions, including tracheotomy, gastrostomy, “ventriculoatrial” shunt placement, and rotated temporalis muscle flap closure. This article presents cases that Illustrate the evolution of the current, “standard skull-base” operative procedure and the rationale for incorporation of the shunt and the muscle flap closure as operative refinements. Their beneficial effects upon postoperative morbidity are detailed.

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Petroclival Meningiomas: Factors Determining the Choice of Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1608654 ◽

2017 ◽

Vol 79 (04) ◽

pp. 367-378 ◽

Cited By ~ 3

Author(s):

Gustavo Isolan ◽

Sâmia Wayhs ◽

Guilherme Lepski ◽

Leandro Dini ◽

Joel Lavinsky

Keyword(s):

Tumor Progression ◽

Cranial Nerve ◽

Tumor Resection ◽

Retrosigmoid Approach ◽

University Hospital ◽

Gross Total Resection ◽

Middle Fossa ◽

Total Resection ◽

Petroclival Meningiomas

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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Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas

Cancers ◽

10.3390/cancers13061451 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1451

Author(s):

Michele Da Broi ◽

Paola Borrelli ◽

Torstein R. Meling

Keyword(s):

Skull Base ◽

Clinical Outcomes ◽

Karnofsky Performance Status ◽

Performance Status ◽

Multivariable Analysis ◽

Advanced Age ◽

Final Visit ◽

Subtotal Resection ◽

Who Grade ◽

Skull Base Meningiomas

Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.

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Surgery of Petroclival Meningiomas: Report of 24 Cases

Neurosurgery ◽

10.1227/00006123-198901000-00003 ◽

1989 ◽

Vol 24 (1) ◽

pp. 12-17 ◽

Cited By ~ 145

Author(s):

Madjid Samii ◽

Mario Ammirati ◽

Ahmed Mahran ◽

Walter Bini ◽

Abholgasse Sepehrnia

Keyword(s):

Cranial Nerve ◽

Transverse Sinus ◽

Surgical Approaches ◽

Common Symptom ◽

City Hospital ◽

Petroclival Meningiomas ◽

Number Of Patients ◽

Microsurgical Techniques ◽

Total Tumor Removal ◽

The City

Abstract Twenty-four patients with petroclival meningiomas were operated upon at the neurosurgical clinic of the City Hospital of Hannover between 1978 and 1987. Seventeen were women and seven men; the mean age was 45 years. Symptoms were usually present for more than 2 years before the diagnosis was made. The most common symptom was disturbance of gait; the most common preoperative sign was cranial nerve deficit, mainly of the 7th and 8th nerves. Preoperative neuroradiological evaluation included computed tomography and four-vessel cerebral angiography. Fifteen patients (62%) had a tumor larger than 2.5 cm in its major diameter. The surgical approaches used were the retromastoid, pterional, subtemporal, and combined retromastoid-subtemporal. We developed a modification of the retromastoid-subtemporal approach with preservation of the transverse sinus and used this in the last 2 patients. There was no postoperative death; 11 patients (46%) suffered postoperative complications, mainly in the form of cranial nerve deficits, often reversible. “Total” tumor removal was achieved in 17 patients (71%). Twenty patients (83%) were independent at the time of discharge from the hospital. With accurate neuroradiological evaluation, careful choice of the surgical approach, and sound application of microsurgical techniques, petroclival meningiomas may be “totally” and safely resected in a significant number of patients.

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Predictors of tumor progression among children with gangliogliomas

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.2.peds0861 ◽

2009 ◽

Vol 3 (6) ◽

pp. 461-466 ◽

Cited By ~ 25

Author(s):

Mostafa El Khashab ◽

Lynn Gargan ◽

Linda Margraf ◽

Korgun Koral ◽

Farideh Nejat ◽

...

Keyword(s):

Risk Factors ◽

Tumor Progression ◽

Cox Regression ◽

Tumor Resection ◽

Progression Free Survival ◽

Initial Presentation ◽

Subtotal Resection ◽

Low Grade ◽

Cox Regression Analysis ◽

Presenting Symptoms

Object Few reports describe the outcome and prognostic factors for children with gangliogliomas. The objective of this report was to describe the progression-free survival (PFS) for children with low-grade gangliogliomas and identify risk factors for tumor progression. Methods A retrospective study was performed in children with low-grade gangliogliomas who were evaluated and treated in the neuro-oncology department between 1986 and 2006 to determine risk factors for subsequent tumor progression. Results A total of 38 children with newly diagnosed gangliogliomas were included in this report. Thirty-four children were treated with surgery alone, 3 with subtotal resection and radiation therapy, and 1 with subtotal resection and chemotherapy. The follow-up ranged from 4 months to 15.8 years (mean 5.7 ± 4.2 years [± SD]). Seven children have experienced tumor progression, and 1 child died after his tumor subsequently underwent malignant transformation. The 5-year PFS was calculated to be 81.2% using Kaplan-Meier survival analysis. Initial presentation with seizures (p = 0.004), tumor location in the cerebral hemisphere (p = 0.020), and complete tumor resection (p = 0.035) were associated with prolonged PFS. Further analysis of the above significant variables by a Cox regression model identified initial presentation with seizures as being associated with prolonged PFS (p = 0.028). Conclusions The PFS and overall survival of children with gangliogliomas are good. Tumors located in the cerebral hemispheres, the achievement of total resection, and seizures at presentation were associated with prolonged PFS. Cox regression analysis identified presenting symptoms including seizures as significant predictive factors of PFS. Prospective studies with larger numbers of children are needed to define the significant factors of tumor progression.

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Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

Journal of Neurosurgery ◽

10.3171/jns.2000.92.2.0235 ◽

2000 ◽

Vol 92 (2) ◽

pp. 235-241 ◽

Cited By ~ 130

Author(s):

Madjid Samii ◽

Marcos Tatagiba ◽

Gustavo A. Carvalho

Keyword(s):

Tumor Resection ◽

Neurological Deficits ◽

Subtotal Resection ◽

Middle Fossa ◽

Meckel’S Cave ◽

Content Type ◽

Simpson Grade ◽

Petroclival Meningiomas ◽

Meckel's Cave ◽

Fine Print

Object. The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).Methods. The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.Conclusions. Theapproach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

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Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Neurosurgical FOCUS ◽

10.3171/2012.7.focus12199 ◽

2012 ◽

Vol 33 (3) ◽

pp. E16 ◽

Cited By ~ 42

Author(s):

Richard K. Gurgel ◽

Salim Dogru ◽

Richard L. Amdur ◽

Ashkan Monfared

Keyword(s):

Facial Nerve ◽

Surgical Approach ◽

Tumor Resection ◽

Extent Of Resection ◽

Vestibular Schwannomas ◽

Surgical Approaches ◽

Subtotal Resection ◽

Total Resection ◽

Translabyrinthine Approach ◽

Better Than

Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

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Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

Neurosurgical FOCUS ◽

10.3171/foc.1999.7.6.1 ◽

1999 ◽

Vol 7 (6) ◽

pp. E1

Author(s):

Madjid Samii ◽

Marcos Tatagiba ◽

Gustavo A. Carvalho

Keyword(s):

Tumor Resection ◽

Petrous Bone ◽

Neurological Deficits ◽

Subtotal Resection ◽

Middle Fossa ◽

Meckel’S Cave ◽

Simpson Grade ◽

Petroclival Meningiomas ◽

Meckel's Cave

Object The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA). Methods The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa. Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients. Conclusions The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

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