Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle

Morrison, A. W.; King, T. T.

doi:10.3171/jns.1973.38.3.0382

Cited by 180 publications

(57 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6). 21,30,37 Additional bone resection in the translabyrinthine approach increased access to the anterolateral brainstem and inferior clivus. However, the translabyrinthine approach sacrifices the labyrinth at the expense of hearing function.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…3 Each differs in the extent of petrous bone resection and has been well described. 3,21,22,30,37,54,58 Progressively aggressive bone removal provides better anatomical exposure and increases surgical freedom. Nevertheless, the increase in exposure and surgical freedom comes at the expense of potentially increasing complication rates.…”

Section: Surgical Approachesmentioning

confidence: 99%

See 1 more Smart Citation

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Karampelas

Megerian³

et al. 2013

FOC

View full text Add to dashboard Cite

Object Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base and proximity to eloquent neurovascular structures. Various skull base approaches have been used in their treatment, and deciding which is the optimal one remains controversial. Attempts at achieving gross- or near-total resections are associated with an increased rate of morbidity and mortality. As adjunctive treatment options such as stereotactic radiosurgery have been developed and become widely available, there has been a trend toward accepting subtotal resections in an effort to minimize neurological morbidity. This paper reviews a recent series of patients with petroclival meningiomas and highlights current management trends and important considerations useful in surgical decision making. Methods The records of patients with large (> 3 cm) petroclival meningiomas surgically treated by the senior author over the past 5 years were reviewed. The clinical results are presented as examples of the surgical approaches available for approaching these tumors, and treatment options are reviewed. Results Of 196 meningiomas surgically treated during the study period, 8 lesions in 8 patients met the study criteria. Overall clinical results were excellent, with no death or major morbidity. Intracranial gross- or near-total resection (Simpson Grade 1, 2, or 3) was achieved in 5 patients (67%). New cranial nerve deficits occurred in 3 patients (37%) and were more common in patients in whom a subtotal resection was performed (2 of 3 cases). A variety of surgical approaches were used. Important considerations determining the best approach include the location of the tumor relative to the internal auditory canal, the presence of preoperative hearing loss, and the location of the tumor relative to the tentorium. Conclusions Achieving gross- or near-total resections of large petroclival meningiomas remains achievable and should be the primary goal of surgical treatment. A retrosigmoid craniotomy remains a workhorse surgical approach for most petroclival tumors of any size. Tumors that are medial to the internal auditory canal and span both middle and posterior cranial fossae are often best treated with a combined transpetrosal approach, which is especially true if there is a preoperative hearing deficit.

show abstract

Section: Surgical Approachesmentioning

confidence: 99%

Section: Surgical Approachesmentioning

confidence: 99%

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Karampelas

Megerian³

et al. 2013

FOC

View full text Add to dashboard Cite

show abstract

“…Operation. On Aug. 15,1973, with the pa tient in the sitting position, the posterior fossa was explored through a left suboccipital craniec tomy and mastoidectomy. The entire length of the sigmoid sinus was exposed and retracted ante rotate rally.…”

mentioning

confidence: 99%

Clivus Meningioma: Six Cases of Total Removal

Hakuba

Nishimura

Tanaka

et al. 1977

Neurol. Med. Chir.(Tokyo)

154

View full text Add to dashboard Cite

SummaryMeningiomas which arise from the clivus are extremely rare. According to Dany8), the incidence of this tumor is 8.4% of the meningiomas of the posterior fossa and 0.125% of all brain tumors. The clinical features of the clivus meningioma consist of asymmentrical bilateral cranial nerve involvements (especially V, VII, VIII, IX, X), cerebellar and long tract signs and increased intracranial pressure. Practically, VAG and CAG are the most useful diagnostic procedures.Results of treatment have been quite disappointing, primarily because of the position of the mass which is anterior to the brain stem and in direct contact with the vertebral and/or basilar artery. Most neurosurgeons would consider it to be inoperable and would simply perform a biopsy or partial removal. However, when the tumor is not too large and hard, total removal of a clivus meningioma should be tried with some precautions. The approach must be chosen to provide the shortest access to the main feeders, and multisided exposure should be obtained according to the location and the extension of the tumor. The results which have been obtained in our own 6 cases are encouraging. Case Reports Case 1. A 45-year-old male presented a 2 year history of difficulty in walking and swal lowing, a one-year history of double vision on looking to his left, leaking of saliva and food from the left corner of the mouth, and a few months history of psychic disturbances such as easy crying and forced laughter.Examination showed left abducens palsy, absent corneal and gag reflex on the left side, left peripheral facial paresis, dysarthria, positive Romberg's sign, horizontal nystagmus on the left lateral gaze, and limb ataxia on the left side. Plain roentgenograms were negative. Bilateral retrograde vertebral angiogram (VAG) dem onstrated that the basilar tip was displaced 2 cm backward (Fig. 1A) and shifted to the right (Fig. 1 B). The left posterior cerebral artery was dis placed upward and arched. The left superior cerebellar artery was shifted backward and medially (Fig. 1 B). Left carotid angiogram (CAG) showed that the carotid siphon was opened. There were several tumor vessels com ing from meningeal branches off the cavernous portion of the left internal carotid artery (Fig. 2). Pneumoencephalograms demonstrated no air in the ventricular system and bilateral ponto cerebellar cisterns. The pericallosal cistern was widened.Operation. On Sep. 25, 1972, left temporo occipital craniotomy and left suboccipital craniectomy as well as left mastoidectomy and removal of the posterior part of the petrosal bone were performed. The left sigmoid sinus was divided. Amputation of the lateral half of the cerebellar hemisphere and tentoriotomy were made. A round granular, hard-elastic, and un suckable mass was located ventral to the brain stem and attached to the left upper lateral part

show abstract

“…During this time there were only 10 suboccipital operations for acoustic neuromas. The surgical technique of the purely translabyrinthine operation has been described in detail (Morrison 1976), while the original translabyrinthine-transtentorial method has been reported by Morrison & King (1973). Certain modifications of the approach were employed and are shown in Table 4.…”

mentioning

confidence: 99%

“…A number of combined approaches have been devised to overcome this: the suboccipital-petrosal approach (Hitselberger & House 1966); the subtemporal transtentorial method (Rosomoff 1971); and the translabyrinthine-transtentorial technique (King 1970, Morrison & King 1973). Other workers, including Dawes & Hankinson (1971) and Ojemann et al (1972), prefer a two-stage operation in which the suboccipital and translabyrinthine approaches are used separately, House and his colleagues (Pulec et al 1971) now appear to favour suboccipital decompression followed a week later by translabyrinthine surgery.…”

mentioning

confidence: 99%

Translabyrinthine Surgical Approach to the Internal Acoustic Meatus

Morrison

1978

J R Soc Med

View full text Add to dashboard Cite

A good surgical approach should offer adequate access to manage the pathology and possible complications; it should be capable of modification to suit the circumstances; and it should be relatively devoid of risk. This versatility is to be found in the translabyrinthine approach to the internal acoustic meatus and cerebellopontine angle if combined, when necessary, with a modified transtentorial dissection.Acoustic neuroma surgery The translabyrinthine approach was first suggested by Panse (1904) and it was performed in 1912 by Quix and later by others. Though Cushing (1917) foresaw combined surgical attacks on this area, he condemned the translabyrinthine operation (Cushing 1921) and it fell into disrepute. For the next forty years the suboccipital operation described by Dandy (1925) was predominantly used, and even today it is preferred by many neurosurgeons. Ironically it is returning to favour with neurosurgeons and otologists since, in the management of smaller vestibular schwannomas, it offers the prospect of preservation of hearing as well as of facial nerve function following total tumour removal (Smith 1977). Regrettably, however, many patients when first seen have large tumours which are not amenable to such preservation, and even among the group with smaller tumours the hearing loss is frequently so severe that there would be little point in attempting to maintain it. Furthermore, Morrison et al. (1976) have drawn attention to the fact that some schwannomas, whatever their nerve or origin, are surgically inseparable from the cochlear division of the VIII cranial nerve; this applied to nearly one in four.House (1964) and Hitselberger & House (1966) pioneered the modern revival of the translabyrinthine operation which, assisted by microsurgical dissection, antibiotics, steroids and by good anaesthesia, is now practised by teams of otologists and neurosurgeons in many centres throughout the world. With increasing experience, surprisingly large tumours can be removed totally by the translabyrinthine approach. The principal advantage is in the surgical management of small and medium-sized tumours when there is very little risk of mortality or morbidity even to the facial nerve (Table I). When the otologist becomes involved in the surgical treatment of these lesions, his searching for smaller tumours is likely to be more enthusiastic and persevering. The advent of computerized axial tomography, while revolutionizing the comfort and safety of diagnosis, has not yet solved this problem. There is still a need for tomographic contrast radiology of the type described by Morris & Wylie (1974) for the demonstration of intracanalicular and smaller angle filling defects.When we come to consider large tumours which have distorted or displaced the brain-stem and which are frequently associated with raised intracranial pressure, the translabyrinthine 1 Paper read to Sectionof Otology at Brighton, 2SJune 1977 0141.0768/78

show abstract

Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle

Cited by 180 publications

References 8 publications

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Clivus Meningioma: Six Cases of Total Removal

Translabyrinthine Surgical Approach to the Internal Acoustic Meatus

Contact Info

Product

Resources

About