Surgical management and follow-up of lateral skull base tumors: An 8-year review

OBJECTIVE The objective of this study was to identify the natural history and clinical predictors of postoperative recurrence of skull base and non–skull base meningiomas. METHODS The authors performed a retrospective hospital-based study of all patients with meningioma referred to their institution from September 1993 to January 2014. The cohort constituted both patients with a first-time presentation and those with evidence of recurrence. Kaplan-Meier curves were constructed for analysis of recurrence and differences were assessed using the log-rank test. Cox proportional hazard regression was used to identify potential predictors of recurrence. RESULTS Overall, 398 intracranial meningiomas were reviewed, including 269 (68%) non–skull base and 129 (32%) skull base meningiomas (median follow-up 30.2 months, interquartile range [IQR] 8.5–76 months). The 10-year recurrence-free survival rates for patients with gross-total resection (GTR) and subtotal resection (STR) were 90% and 43%, respectively. Skull base tumors were associated with a lower proliferation index (0.041 vs 0.062, p = 0.001), higher likelihood of WHO Grade I (85.3% vs 69.1%, p = 0.003), and younger patient age (55.2 vs 58.3 years, p = 0.01). Meningiomas in all locations demonstrated an average recurrence rate of 30% at 100 months of follow-up. Subsequently, the recurrence of skull base meningiomas plateaued whereas non–skull base lesions had an 80% recurrence rate at 230 months follow-up (p = 0.02). On univariate analysis, a prior history of recurrence (p < 0.001), initial WHO grade following resection (p < 0.001), and the inability to obtain GTR (p < 0.001) were predictors of future recurrence. On multivariate analysis a prior history of recurrence (p = 0.02) and an STR (p < 0.01) were independent predictors of a recurrence. Assessing only patients with primary presentations, STR and WHO Grades II and III were independent predictors of recurrence (p < 0.001 for both). CONCLUSIONS Patients with skull base meningiomas present at a younger age and have less aggressive lesions overall. Extent of resection is a key predictor of recurrence and long-term follow-up of meningiomas is necessary, especially for non–skull base tumors. In skull base meningiomas, recurrence risk plateaus approximately 100 months after surgery, suggesting that for this specific cohort, follow-up after 100 months can be less frequent.

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Outcomes in Surgical Management of Sinonasal/Skull Base Tumors: A Single Comprehensive Cancer Center Experience

10.1055/s-0041-1725351 ◽

2021 ◽

Author(s):

Dauren Adilbay ◽

Cristina Valero ◽

Conall Fitzgerald ◽

Avery Yuan ◽

Ximena Mimica ◽

...

Keyword(s):

Skull Base ◽

Surgical Management ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Skull Base Tumors

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Transnasal endoscopic approach for pediatric skull base lesions: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18693 ◽

2019 ◽

Vol 24 (3) ◽

pp. 246-257 ◽

Cited By ~ 1

Author(s):

Jennifer L. Quon ◽

Lily H. Kim ◽

Peter H. Hwang ◽

Zara M. Patel ◽

Gerald A. Grant ◽

...

Keyword(s):

Skull Base ◽

Pediatric Population ◽

Case Series ◽

Length Of Hospital Stay ◽

Skull Base Tumors ◽

Presenting Symptoms ◽

Institutional Experience ◽

Transnasal Endoscopic Approach ◽

Skull Base Lesions

OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

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Studio Angio-RM dei tumori del basicranio

Rivista di Neuroradiologia ◽

10.1177/19714009970100s263 ◽

1997 ◽

Vol 10 (2_suppl) ◽

pp. 152-154

Author(s):

S. Duca ◽

S. Crasto ◽

E. Salzedo ◽

P. Bertone ◽

P. Petricig

Keyword(s):

Skull Base ◽

Spatial Resolution ◽

Mr Angiography ◽

Vascular Involvement ◽

Slow Flow ◽

Skull Base Tumors ◽

Radio Chemotherapy ◽

Mr Brain

In a population of 59 patients with skull base tumors the authors made 75 MR brain and angiographic examinations to assess the efficacy of MR Angiography in the evaluation of vascular involvement of these tumors. The authors conclude that RMA gives a good map of the involvement of the great arterial and venous vessels from skull base tumors, but its low spatial resolution is not competitive with traditional angiographic techniques, in particular in the evaluation of the small arterial vessels and slow flow venous channels. MRA is useful in the follow-up of these tumors, particularly after radio-chemotherapy and after radiosurgery.

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Transcervical Approach for Resection of Lateral Skull Base Tumors

Journal of Otology ◽

10.1016/s1672-2930(07)50021-8 ◽

2007 ◽

Vol 2 (2) ◽

pp. 102-108 ◽

Cited By ~ 1

Author(s):

Liu Jian-feng ◽

Zhang Qiu-hang ◽

Yang Da-zhang ◽

Qu Qiu-yi

Keyword(s):

Skull Base ◽

Skull Base Tumors ◽

Transcervical Approach ◽

Lateral Skull Base

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Radiosurgery for large-volume (> 10 cm3) benign meningiomas

Journal of Neurosurgery ◽

10.3171/2009.8.jns09703 ◽

2010 ◽

Vol 112 (5) ◽

pp. 951-956 ◽

Cited By ~ 34

Author(s):

Jonathan M. Bledsoe ◽

Michael J. Link ◽

Scott L. Stafford ◽

Paul J. Park ◽

Bruce E. Pollock

Keyword(s):

Skull Base ◽

Large Volume ◽

Tumor Control ◽

Skull Base Tumors ◽

Who Grade ◽

Average Tumor Volume ◽

The Mean ◽

Skull Base Meningiomas ◽

Supratentorial Tumors

Object Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1–48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12–18 Gy); and the mean follow-up duration was 70.1 months (range 12–199 months). Results Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3–6.7, p = 0.01). Conclusions The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

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Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

Journal of Neurosurgery ◽

10.3171/2016.9.jns16997 ◽

2018 ◽

Vol 128 (2) ◽

pp. 631-638 ◽

Cited By ~ 6

Author(s):

Sampath Chandra Prasad ◽

Karthikeyan Balasubramanian ◽

Enrico Piccirillo ◽

Abdelkader Taibah ◽

Alessandra Russo ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Skull Base Tumor ◽

Nerve Function ◽

Postoperative Result ◽

Lateral Skull Base ◽

Number Of Patients ◽

Study Results ◽

Grade Iii

OBJECTIVEThe aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries.METHODSThe authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system.RESULTSTwo hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002).CONCLUSIONSCable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue–aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

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