Large and giant skull base meningiomas: The role of radical surgical removal

Silva, Carlos Eduardo da; Freitas, Paulo Eduardo Peixoto de

doi:10.4103/2152-7806.159489

Cited by 26 publications

(23 citation statements)

References 34 publications

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“…Complete resection classified as Simpson grades I and II was achieved in 72% of all patients in our series, with a trend towards subtotal resection in medially located TMs that was not statistically significant (Table 4) and TMs that invade sinuses (Table 2). These results are conform with those of recent publications 3,9,19,20 .…”

Section: Discussionsupporting

confidence: 94%

“…We aimed to describe the surgical and functional outcome with respect to tumor location and surgical approach. Various publications on skull base and posterior fossa meningiomas have contributed to the evidence in the recent decades and as is common strategy with any intracranial meningioma, an aggressive surgical management is advocated for optimal oncological outcome and progression-free survival 9 . Unsurprisingly, TMs represent a peculiar subgroup with difficult to manage hallmarks, most notably their location in between two compartments and close association to vital neurovascular structures.…”

Section: Discussionmentioning

confidence: 99%

“…Brain stem compression and affection of cranial nerves as well as invasion into large draining vessels pose a challenge to the operating surgeon and are characteristic 6,10–12 . Overall, complication rates reached 23–34% in early series that applied a tailored approach for complete removal according to the lesion’s location on the tentorium, with CSF fistulae and hydrocephalus being the most common postoperative complications 9,13–15 . Subsequently, several series reported a subpar oncological outcome as a necessary trade-off for preservation of neurological function, although postoperative neurological morbidity still ranged between 23–33% in these analyses 12,16 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

Wagner

Joerger

Lange

et al. 2019

Sci Rep

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Tentorial meningiomas (TMs) may challenge the surgeon with their close association to neurovascular structures. We analyzed a consecutive series with regard to surgical and functional outcome following microsurgical resection. We retrospectively reviewed patient charts and imaging data of every patient with a TM resected at a single institution and compared surgical and functional outcomes between groups stratified by choice of approach. 57 consecutive patients from October 2006 to September 2017 were included, of which 75.4% were female; mean age was 60 years (range 31–90), follow-up data was available for 85.4% and reached a mean of 18.3 (range 2–119) months with a median of 14.5 months. 54.4% of TMs were located at the medial compartments of the tentorium, 45.6% at the lateral edges. Complete resection defined as Simpson grades I and II was achieved in 72% of all cases, without statistically significant differences for both subgroups (p = 0.532). 9 patients (15.8%) developed a new cranial nerve palsy postoperatively with the vestibulocochlear nerve affected exclusively in the lateral subgroup (8.8% of total), followed by disturbances of oculomotion (5.4%). After 12 months, 93.0% of patients with available follow-up after 12 months retained fully independent functional status without deficit. Despite providing a surgical challenge due to potentially complicated anatomical relations, the choice of an appropriate surgical strategy overall results in favourable oncological and functional outcome after resection of TMs.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

Wagner

Joerger

Lange

et al. 2019

Sci Rep

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“…We operated seven cases of large anterior skull base meningiomas (defined as maximum diameter >3 cm). [6] Of seven meningiomas, four were located in the planum sphenoidale, two were in the orbital roof at the fronto-orbital junction, and one was located at tuberculum sellae. Headache was the most common presentation and was seen in 5/7 cases.…”

Section: Resultsmentioning

confidence: 99%

Supraorbital craniotomy for large anterior skull base meningiomas: A technical note

et al. 2019

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Background: Supraorbital craniotomy (SOC) has brought a paradigm shift in approaching anterior skull base lesions. With better understanding of relevant anatomy, the indications are being stretched from highly selected, small-to-moderate-sized tumors to large and complex anterior skull base lesions. Objective: We share our experience and discuss the nuances of surgery for large anterior skull base meningiomas using the SOC. Methods: This is a single institute study using prospectively collected retrospective data from seven cases of large anterior skull base meningiomas (>3 cm) using the SOC. We reviewed the indications, safety, and procedural complications in these cases. Results: Simpson's Grade 2 excision was achieved in all these seven cases, with faster postoperative recovery. Follow-up clinical outcome and cosmesis were satisfactory. Conclusion: SOC is a safe alternative for the standard skull base approaches in treating large anterior skull base meningiomas. The SOC can be effectively used to treat selected large anterior skull base meningiomas.

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“…►Table 5 shows the comparative results with major surgical series of petroclival meningiomas. 4,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Tumors with extension into the middle fossa, more precisely extending above the tentorium notch, were ap-proached through an access to the lateral skull base. Once the tentorium is completely transected, petrosal approaches provide a better view of the entire tumor extension in a single procedure in cases of real midline retroclival tumors, with supratentorial and middle fossa invasion.…”

Section: Discussionmentioning

confidence: 99%

Petroclival Meningiomas: Factors Determining the Choice of Approach

et al. 2017

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To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Retrospective review. The study was conducted in a university hospital in southern Brazil. Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Retrosigmoid approach was used in tumors<3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6-75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.

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Large and giant skull base meningiomas: The role of radical surgical removal

Cited by 26 publications

References 34 publications

Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

Supraorbital craniotomy for large anterior skull base meningiomas: A technical note

Petroclival Meningiomas: Factors Determining the Choice of Approach

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