Differences in clinical presentation, intraoperative findings and outcome between petroclival and lateral posterior pyramid meningioma

Pintea, Bogdan; Kandenwein, J. A.; Lorenzen, Henning; Blume, Carina Andriatta; Daher, Frederick H.; Kristof, Rudolf A.

doi:10.1016/j.clineuro.2016.01.012

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…The factors that make meningiomas complex and difficult to safely remove in a single operation can be mitigated through staged surgeries which allow for more measured and safer complete resection. 12,24 We detail a flow diagram that was created based on our own experiences along with the trends and patterns we observed in this literature review in Figure 3, which we created to provide an organized algorithm that can aid skull base surgeons in the preoperative planning phase (Figure 3).…”

Section: Considerations For a Staged Approachmentioning

confidence: 99%

“…Tough tumor consistency, shared pial vascularity, major vessel encasement and cranial nerve invasion Permanent 4th nerve palsy in 1/6 patients Pintea et al 12 To resect supratentorial portion of the tumors -Tamaki et al 13…”

Section: Hart Et Al 11mentioning

confidence: 99%

“…Three patients underwent temporopolar alternating in conjunction with combined petrosal strategies (2 surgeries) Two patients underwent an infratemporal approach combined with petrosal approach (2 surgeries) One patient underwent orbitozygomatic and a combined petrosal paradigm (3 surgeries) Pintea et al 12 Petroclival and lateral posterior pyramid meningioma -Tamaki et al 13 Olfactory groove - 21 Petroclival Patient one, 1st: staged anterior petrosectomy; 2nd: retromastoid suboccipital craniectomy, Patient two, 1st: Dtaged presigmoid, 2nd: half-and-half approach(trans-Sylvian with subtemporal) Javed et al 22 Clival/petroclival -Nakase et al 23 Cavernous sinus meningiomas, sphenoid-ridge meningioma, cerebello-pontine angle meningioma Unspecified stages: frontotemporal-orbitozygomatic approach, posterior transpetrosal approach, anterior transpetrosal approach Ansari et al 24 2 falcotentorial, 1 anterior and middle parasagittal, 1 sphenoid wing 1st: Craniotomy where hypervascular bone was excised along with the opening of the dura in the first stage; 2nd: complete removal of tumor…”

Section: Cranial Basementioning

confidence: 99%

“…The Yokoi et al 42 Sphenoid ridge with cavernous sinus involvement 1st: Endoscopic endonasal transsphenoidal 2nd: Craniotomy early visualization of the cranial nerves offered by this approach in the posterior fossa coupled with the accessibility to the petroclival region makes it an efficient and facile approach for many neurosurgeons who prefer it over more complex skull base approaches (as illustrated by several cases). 12,[18][19][20]37,45 Suprameatal drilling offers the added advantage of removing tumor burden that extends into the middle cranial fossa through Meckel's cave, but these advantages can be limited by larger tumors with significant tumor burden in the middle cranial fossa. Alternatively, the presigmoid approach allows for exposure of the upper clival region during the resection of large meningiomas.…”

Section: Considerations For a Staged Approachmentioning

confidence: 99%

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Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Gendreau

Kuo

Patel

et al. 2023

J Neurol Surg B Skull Base

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Introduction: Meningiomas are extra-axial intracranial tumors that are characterized as benign and slow-growing intracranial tumors of the dura. Large meningiomas encroach on critical vascular and neural structures, sometimes making gross total resection challenging. Multi-staged surgeries are becoming increasingly utilized as they can help improve safe resection while minimizing adverse sequela. Methods: PubMed, Scopus and Web of Science databases were queried to identify articles reporting resections of intracranial meningiomas using a multi-staged approach, and articles were screened for possible inclusion in a systematic process performed by two authors. Results: Of 118 identified studies, 36 describing 169 patients (mean age 42.6±21.3 years) met inclusion/exclusion criteria. Petroclival lesions comprised 57% of cases, with the most common indications for a multi-staged approach being large size, close approximation of critical neurovascular structures, minimization of brain retraction, identification and ligation of deep vessels feeding the tumor, and resection of residual tumor found on postoperative imaging. Most second stage surgeries occurred within 3 months of the index surgery. Few complications were reported and multi-staged resections appeared to be well tolerated overall. Conclusions: Current literature suggests multi-staged approaches for meningioma resection are well-tolerated. However, there is insufficient comparative evidence to draw definitive conclusions about its advantages over an unstaged approach. There are similarly insufficient data to generate an evidence-based decision-making framework for when a staged approach should be employed. This highlights the need for collaborative efforts amongst skull base surgeons to establish an evidentiary to support the use of staged approaches.

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Section: Considerations For a Staged Approachmentioning

confidence: 99%

Section: Hart Et Al 11mentioning

confidence: 99%

Section: Cranial Basementioning

confidence: 99%

Section: Considerations For a Staged Approachmentioning

confidence: 99%

See 2 more Smart Citations

Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Gendreau

Kuo

Patel

et al. 2023

J Neurol Surg B Skull Base

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“…In general, the first choice in the treatment of meningioma is microsurgical resection. However, especially at sites nearby or with involvement of critical structures like the optic nerve, the brainstem and in the course of cranial nerves, microsurgical resection has low potential of functional improvement [1][2][3]31]. Taking into consideration the low morbidity profile of fSRT in the treatment of ONSM in our trial as well in other trials, we propagate an early treatment start [4,5,7,8,[15][16][17][18][20][21][22][23][24][25][26]32].…”

Section: Therapeutic Consequencesmentioning

confidence: 99%

Prognostic Factors for Functional Outcome of Patients with Optic Nerve Sheath Meningiomas Treated with Stereotactic Radiotherapy–Evaluation of Own and Meta-Analysis of Published Data

Pintea

Boström²,

Katsigiannis

et al. 2021

Cancers

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Objective: To evaluate prognostic factors for a favorable outcome (improvement of the visual acuity or visual fields) after fractionated stereotactic radiotherapy (fSRT) of optic nerve sheath meningioma (ONSM). Methods: We performed a database search for ONSM treatments during the period from April 2008 to September 2019 in the prospective database for stereotactic radiosurgery/radiotherapy (SRS/SRT) of the Robert Janker Clinic Bonn (Department of Radiotherapy) and performed a literature review and meta-analysis of published data on ONSM between 2010 and 2019. Ophthalmic status before and after treatment was evaluated and the collective was dichotomized into two groups: functional improvement (FI; improvement of either visual acuity or visual fields) and non functional improvement (NFI; with stable or deteriorating visual acuity or visual fields). The two groups were compared regarding different variables: pretreatment visual acuity, age, gender, gross tumor volume (GTV), follow up (FU) time, tumor localization, and maximal retina dose. Results: Overall, 13 stereotactic radiotherapies were performed for ONSM (12 × fSRT, 1 × SRS). Mean follow up was 3 years (range: 1–5 years). The total dose was 50.4 Gy (5 × 1.8 Gy/week) in 12 patients treated with fSRT and 1 × 14 Gy in one SRS case. Mean GTV was 1.13 ccm (range: 0.44–2.20 ccm). During follow up, all tumors were stable or showed shrinkage of tumor volume (100% tumor control), no adverse events were observed, 53% of the patients achieved either better visual acuity or visual fields. Pretreatment visual acuity was significantly different between the FI and the NFI group (0.17 vs. 0.63, p = 0.03) in our series and in the meta analysis (p < 0.01). Moreover, shorter FU time and lower retinal dose were significantly linked (p < 0.05 and p < 0.01, respectively) with a better outcome in the meta-analysis but not in our patient cohort. Intracranial tumor localization, gender, and age were not significantly different between the two outcome groups. Conclusion: FSRT for ONSM achieves in over 50% of cases an improvement of the ophthalmic status with low morbidity and excellent tumor control in our series and the meta analysis. Patients with a favorable outcome had in all analysis a significantly higher visual acuity before treatment start. Therefore, we advocate using fSRT as early as possible before vision deterioration occurs.

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Role of the neurotologist in posterior fossa meningioma surgery

Cheung

Russell

Pross

2020

Handbook of Clinical Neurology

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Differences in clinical presentation, intraoperative findings and outcome between petroclival and lateral posterior pyramid meningioma

Cited by 8 publications

References 27 publications

Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Prognostic Factors for Functional Outcome of Patients with Optic Nerve Sheath Meningiomas Treated with Stereotactic Radiotherapy–Evaluation of Own and Meta-Analysis of Published Data

Role of the neurotologist in posterior fossa meningioma surgery

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