Contacting Neurosurgery

Little, Kenneth M.; Friedman, Allan H.; Sampson, John H.; Wanibuchi, Masahiko; Fukushima, Takanori

doi:10.1227/01.neu.0000153906.12640.62

Cited by 221 publications

(140 citation statements)

References 27 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…With the advent of radiosurgery, many have recommended subtotal removal and subsequent radiosurgery to avoid operative morbidity 1,7,21,28,33,34,42 One of the arguments for this approach is that subtotal removal decreases the likelihood of cranial nerve dysfunction and thus improves quality of life, and that pairing this approach with postoperative radiation may form the basis of safer tumor control. Cranial nerve dysfunction may still occur with a more cautious surgical approach and is often temporary after total or partial removal.…”

mentioning

confidence: 99%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

130

121

View full text Add to dashboard Cite

Object The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. Methods The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O.A.) from 1988 to 2012, strictly defined as those originating medial to the fifth cranial nerve on the upper two-thirds of the clivus. The patients' average age was 49 years; the average tumor size (maximum diameter) was 35.48 ± 10.09 mm (with 59 tumors > 20 mm), and cavernous sinus extension was present in 39 patients. The mean duration of follow-up was 71.57 months (range 4–276 months). Results In 42 patients, the operative reports allowed the grading of resection. Grade I resection (tumor, dura, and bone) was achieved in 17 patients (40.4%); there was no recurrence in this group (p = 0.0045). Grade II (tumor, dura) was achieved in 15 patients (36%). There was a statistically significant difference in the rate of recurrence with respect to resection grade (Grades I and II vs other grades, p = 0.0052). In all patients, tumor removal was classified based on postoperative contrast-enhanced MRI, and gross-total resection (GTR) was considered to be achieved if there was no enhancement present; on this basis, GTR was achieved in 41 (64%) of 64 patients, with a significantly lower recurrence rate in these patients than in the group with residual enhancement (p = 0.00348). One patient died from pulmonary embolism after discharge. The mean Karnofsky Performance Status (KPS) score was 85.31 preoperatively (median 90) and improved on follow-up to 88, with 30 patients (47%) having an improved KPS score on follow-up. Three patients suffered a permanent deficit that significantly affected their KPS. Cerebrospinal fluid leak occurred in 8 patients (12.5%), with 2 of them requiring exploration. Eighty-nine percent of the patients had cranial nerve deficits on presentation; of the 54 patients with more than 2 months of follow-up, 21 (32.8%) had persisting cranial nerve deficits. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6.2%. There was no difference with respect to immediate postoperative cranial nerve deficit in patients who had GTR compared with those who had subtotal resection. Conclusions Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.

show abstract

mentioning

confidence: 99%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

130

121

View full text Add to dashboard Cite

show abstract

“…Because skull base tumors often have extended osseous components that grossly distort normal anatomy, intraoperative orientation might be further compromised. 2,16,25 Therefore, aggressive resection can be associated with significant morbidity, and previously many of these lesions were considered unresectable. The development of complex neurosurgical approaches to the skull base and orbit as well as interdisciplinary operation teams including ophthalmic, otorhinolaryngological, and craniomaxillofacial surgeons led to a drop in morbidity rates while extent of resection increased.…”

Section: Discussionmentioning

confidence: 99%

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

View full text Add to dashboard Cite

S kull base tumors with close anatomical association to orbit, optic nerve, and the cavernous sinus often cause neurological symptoms like loss of visual function and exophthalmus. In most cases resection (complete or partial removal) is the most promising and most effective therapeutic approach with regard to preservation or restoration of visual function. Furthermore, operative tumor removal or reduction is a crucial step in multidisciplinary operative as well as medical or radiotherapeutic treatment concepts, because it allows exact histological diagnosis and safe decompression of anatomical structures at risk. However, resection of these tumors is associated with increased perioperative morbidity due to the proximity of highly sensitive structures-e.g., cranial nerves abbreviatioNs CN = cranial nerve; iCT = intraoperative CT; iMRI = intraoperative MRI; NNS = neuronavigational system. obJective Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. methods Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. results Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned ...

show abstract

“…We did not perform systematic radical resection when we estimated that the tumor could not be safely dissected from the brainstem, the vessels, or the preoperatively intact cranial nerves. 1,9 Radical resection was not generally our main goal, since remnant tumor could be treated by stereotactic radiosurgery in a second stage. 13 …”

Section: Approaches and Surgical Techniquementioning

confidence: 99%

Decision making for the surgical approach of posterior petrous bone meningiomas

Roche

Lubrano

Noudel

et al. 2011

FOC

View full text Add to dashboard Cite

Object The authors undertook this study to examine the surgical approaches used to treat posterior petrous bone meningiomas at a single institution and retrospectively evaluate their surgical strategy based on a previously published classification. Methods Cases in which craniotomies were performed to treat posterior petrous bone meningiomas between 2002 and 2010 were retrospectively reviewed. Data were examined from 57 patients who were treated for 59 tumors. The tumors were classified into 3 types according to the location of their primary dural attachment: Type A, located around the porus trigeminus (33 tumors); Type M, located at the level of the porus of the internal auditory canal (IAC) (12 tumors); and Type P, located laterally to the IAC (14 tumors). The median tumor diameter was 34 mm (range 20–67 mm). Results The choice of the approach was based on tumor location, as the displacement of vascular structures and cranial nerves was primarily determined by the site of dural attachment on the posterior petrous bone. An anterior petrosectomy was performed in 82% of Type A meningiomas, and a retrosigmoid approach was used in 86% of Type P meningiomas. The spectrum of approaches was less uniform for Type M meningiomas. Overall, total resection was obtained in 39% of all cases, and in 18%, 50%, and 86% of Type A, Type M, and Type P tumors, respectively. The postoperative mortality rate was 8.8% (5 deaths among 57 patients), and all 5 patients who died during the early postoperative period had large Type A tumors. At last follow-up, the functional preservation of the facial nerve was excellent in 49 (94%) of the 52 surviving patients. Conclusions The authors believe that proper selection of the approach favorably impacts functional outcome in patients undergoing surgery for the treatment of skull base tumors. In the authors' case series of posterior petrous bone meningiomas, Type P and most Type M tumors were safely managed through a regular retrosigmoid approach, whereas Type A tumors were optimally treated via an epidural anterior petrosectomy.

show abstract

Contacting Neurosurgery

Cited by 221 publications

References 27 publications

True petroclival meningiomas: results of surgical management

True petroclival meningiomas: results of surgical management

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Decision making for the surgical approach of posterior petrous bone meningiomas

Contact Info

Product

Resources

About