Contemporary surgical outcome for skull base meningiomas

Chen, Chien Min; Huang, Abel Po‐Hao; Kuo, Lu-Ting; Tu, Yong Kwang

doi:10.1007/s10143-011-0321-x

Cited by 35 publications

(30 citation statements)

References 111 publications

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“…1,5,15 Facial nerve (CN VII) palsy is a particularly adverse outcome of surgery within the CPA, occurring in 6% to 29% of patients and causing disfiguring and disabling facial paralysis that detracts from a patient's quality of life. 1,10,14,16 Multiple factors, including preoperative facial nerve status, surgical approach, anatomical location, and involvement of the IAC, likely contribute to perioperative CN VII dysfunction.…”

Section: 25mentioning

confidence: 99%

“…14,16 In general, the morbidity associated with CPA meningiomas is attributed to the way the tumors surround or infiltrate nearby cranial nerves and/or the brainstem. 5 In light of this, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. This is in part due to the concurrent rise of Gamma Knife radiosurgery (GKRS) as an acceptable treatment modality for newly diagnosed, recurrent, or progressive meningiomas within the posterior fossa, with large series demonstrating excellent tumor control rates and minimal adverse effects.…”

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confidence: 99%

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Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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Section: 25mentioning

confidence: 99%

mentioning

confidence: 99%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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“…[1,2] Poor accessibility, more complex approach, and dural attachments that cannot be sacrificed, which are all characteristic of SB meningiomas, are factors which contribute to this difference.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of pediatric skull base meningiomas

et al. 2012

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PURPOSE: Meningiomas in children are rare, especially those located at the skull base. In this study, we report our experience of meningioma surgery in the pediatric population and compare our findings of skull base (SB) versus non-skull base (NSB) meningiomas. METHODS: From our database of 724 surgically treated meningioma patients at the University Hospital, Zurich between 1995 and 2010, 12 patients under 18 years of age were identified. Data for those patients was retrospectively collected through chart review. A descriptive comparison between SB and NSB meningiomas was undertaken to determine statistical significance. RESULTS: In all 12 children (seven males, five females; mean age 12.2 ± 4.3 years), surgical removal of the meningioma was performed microsurgically with a mean follow-up of 53 months (range 12-137 months). Of the 12 tumors, six were located in the SB and six in the NSB. Comparing SB to NSB lesions, the mean age was 11 ± 3.8 versus 14 ± 4.6 years, male/female gender distribution was 5:1 compared to 1:5, mean tumor size was 7.5 ± 6.2 versus 26 ± 15.8 cm(2) (p = 0.03), and mean surgery time was 347 versus 214 min. While WHO grade was similar for both groups, the Simpson grade revealed more extensive resection for NSB meningiomas. The Glasgow Outcome Scale at last follow-up was favorable for both groups. CONCLUSIONS: Meningioma surgery was safe with favorable outcomes. SB meningiomas were significantly smaller in size, were less likely to undergo complete resection, and had a predilection for younger, male patients. Surgical Resection of Pediatric Skull Base Meningiomas Keywords:Pediatric meningiomas, skull base meningioma, neurosurgery, resection 2 AbstractPurpose Meningiomas in children are rare, especially those located at the skull base. In this study, we report our experience of meningioma surgery in the pediatric population and compare our findings of skull base (SB) versus non-skull base (NSB) meningiomas.Methods From our database of 724 surgically-treated meningioma patients at the University Hospital, Zurich between 1995 and 2010, 12 patients under 18 years of age were identified.Data for those patients was retrospectively collected through chart review. A descriptive comparison betweent SB and NSB meningiomas was undertaken to determine statistical significance.Results In all 12 children (7 males, 5 females; mean age 12.2 ± 4.3 years) surgical removal of the meningioma was performed microsurgically with a mean follow-up of 53 months (range 12-137 months). Of the 12 tumors, 6 were located in the SB and 6 in the NSB. Comparing SB to NSB lesions, the mean age was 11 ± 3.8 years versus 14 ± 4.6 years; male:female gender distribution was 5:1 compared to 1:5, mean tumor size was 7.5 ± 6.2 cm 2 versus 26 ± 15.8 cm 2 (p=0.03) and mean surgery time was 347 minutes versus 214 minutes. Whilst WHO grade was similar for both groups, the Simpson grade revealed more extensive resection for NSB meningiomas. The Glasgow outcome scale at last follow up was favorable for both groups.Conclusions...

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“…Additionally, table 2 gives an overview depicting morbidity and mortality following surgery for skull base meningiomas basing on a review of Chen et al which mainly included outcome reports published from 2000 to the present (Chen et al 2011) . , mean follow-up of 4.5-5.9 years 9.7-55% 0-3.7% Table 2.…”

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confidence: 99%

“…, mean follow-up of 4.5-5.9 years 9.7-55% 0-3.7% Table 2. Outcome after surgical resection of skull base meningiomas of different locations (modified after Chen et al 2011).…”

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confidence: 99%