Mortality and morbidity in surgically treated patients with petroclival meningiomas: a systematic review and meta-analysis of case series

Barić, Hrvoje; Trkulja, Vladimir; Peterković, Vjerislav; Mrak, Goran

doi:10.1080/02688697.2022.2033700

Cited by 3 publications

(7 citation statements)

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“…6,8,13 A prior meta-analysis demonstrated that approach selection does not affect the rates of CN deficits. 4 In this study, longer operative time and two-stage surgery were associated with new or worsened persistent neurological deficit, likely reflecting increased complexity. 18 This should not discourage staged approaches because these are often necessary for adequate resection when combining approaches or to reduce risk related to long operations.…”

Section: Comparison With Previous Studiesmentioning

confidence: 64%

“…Prior case series reported rates of complication ranging from 5% to 17%, CSF leaks from 6% to 10%, and infection from 10% to 17.4%. 4,8,10,11,18 Mortality rates have ranged from 0% to 9% with more recent series reporting 0% similar to the current cohort. 13 The rate of CSF leak and pseudomeningocele in the current cohort (15.4%) is higher than those previously reported, potentially due to increased use of the posterior petrosal approach (78.5%), a known risk factor.…”

Section: Discussionmentioning

confidence: 75%

“…6,8,9,11-13,18 In 2 recent meta-analyses, the rate of extremity weakness was 10.3%–14%, slightly lower than the 15.3% observed in the present cohort. 4,17 Lack of consensus regarding the definition of petroclival meningiomas means that meta-analyses may include a more heterogeneous population of tumors than those in our study. Inclusion criteria for tumors in this cohort were based on the position of the trigeminal nerve noted intraoperatively, excluding anterior petrous meningiomas which are located between the petrous-occipital suture and internal auditory canal, not as frequently adherent to the basilar artery or perforators, and have a different neurological deficit profile.…”

Section: Discussionmentioning

confidence: 95%

“…The most common postoperative new CN palsy was CN VII which has also been noted in prior metaanalyses. 4,17 The rates of postoperative CN deficits in the literature range from 23% to 76%. 6,8,9,[11][12][13]18 In 2 recent meta-analyses, the rate of extremity weakness was 10.3%-14%, slightly lower than the 15.3% observed in the present cohort.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…3 However, owing to proximity to cranial nerves (CNs) and the anterior and posterior circulation, surgery can result in significant postoperative neurological deficits and complications postoperative. 4,5 Prior meta-analyses have noted inconsistency in the reporting of comprehensive petroclival clinical outcomes. Furthermore, there is a paucity of data on the impact of surgical experience on outcomes for these patients.…”

mentioning

confidence: 99%

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Postoperative Complications and Neurological Deficits After Petroclival Region Meningioma Resection: A Case Series

Nguyen

Morshed

Cheung

et al. 2023

Operative Neurosurgery

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BACKGROUND: Surgical management of meningiomas involving the petroclival junction remains a challenge because of nearby critical neurovascular structures. OBJECTIVE: To describe surgical approach selection, outcomes, and factors associated with postoperative complications and neurological deficits in a series of patients undergoing resection of petroclival region meningiomas. METHODS: Retrospective review of patients undergoing symptomatic petroclival region meningioma resection was performed. Logistic regression was performed to identify variables associated with postoperative complications and new neurological deficits. RESULTS: Sixty-five patients underwent 54 one-stage and 11 two-stage resections with median follow-up of 51 months. Most tumors were World Health Organization grade 1 (90.8%), and the median volume was 23.9 cm3. Posterior petrosectomy and anterior petrosectomy were performed in 67.1% and 6.6% of operations, respectively. The gross or near total resection rate was 15.4%, and 8 patients (12.3%) progressed on follow-up. The surgical complication rate was 26.2% with no perioperative mortalities. Postoperatively, 45.8% of patients had new, persistent neurological deficits, with cranial nerves VII palsy being most common. On multivariate analysis, higher body mass index (odds ratio [OR]: 1.1, P = .04) was associated with risk of surgical complications. Longer operative time (OR: 1.4, P = .004) and staged procedures (OR: 4.9, P = .04) were associated with risk of new neurological deficit on follow-up, likely reflecting more challenging tumors. Comparing early vs later career surgeries performed by the senior author, rates of severe complications and neurological deficits decreased 23.1% and 22.3%, respectively. CONCLUSION: Petroclival region meningiomas remain surgically challenging, but improved outcomes are seen with surgeon experience. These data help inform patients on perioperative morbidity risk and provide a guide for surgical approach selection.

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Section: Comparison With Previous Studiesmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Postoperative Complications and Neurological Deficits After Petroclival Region Meningioma Resection: A Case Series

Nguyen

Morshed

Cheung

et al. 2023

Operative Neurosurgery

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Surgical management of skull base meningiomas and vestibular schwannomas

Gambacciani

Grimod

Sameshima

et al. 2022

Current Opinion in Oncology

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Purpose of reviewThe aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base.Recent findingsMeningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity. Also, the widespread use of neuroimaging and the progressive and constant aging of the populations inevitably result in the increase of detection rate of incidental (asymptomatic) neoplasm.Nowadays, there are still controversies about the correct management strategy.SummarySurgery represents the gold standard treatment, with the objective of gross total resection; however, it is not always feasible due to localization, encasement of neuro-vascular structure, invasion of cranial nerve and brain parenchyma. Stereotactic radiosurgery and radiation therapy are important to achieve a satisfactory functional outcome and tumor control in case of residue or recurrence. A multidisciplinary approach is pivotal.

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Retrosigmoid Suprameatal Approach for the Resection of a Petrotentorial and a Petroclival Meningioma: 3-Dimensional Operative Video

Guinto-Nishimura,

Sangrador-Deitos,

Uribe-Pacheco

et al. 2024

Operative Neurosurgery

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Posterior skull base meningiomas pose a formidable surgical challenge because of their proximity to critical neurovascular structures and the narrow corridor available for their resection. While radiosurgery may be an effective treatment alternative, 1 microsurgery remains superior in addressing associated compressive symptoms. 2 Several approaches have been described to access these lesions, with varying degrees of exposure to the petroclival region. 3-7 The choice of the optimal approach depends on different factors related to the tumor morphological features and the surgeon's preference and experience. The retrosigmoid approach is a straightforward procedure compared with other more laborious skull base approaches to the petroclival region. Its described intradural extensions contribute to its high versatility for posterior skull base tumors. One of these extensions involves drilling the suprameatal tubercle, significantly increasing exposure and maneuverability for tumors located medial to the internal acoustic canal. 8 The semisitting position adds further value as it allows for a gravity-assisted clearance of blood and debris, achieving a clear surgical field. 9 We present 2 patients suffering from trigeminal neuralgia secondary to a petrotentorial and a petroclival meningioma. Given the location of both tumors predominantly medial and superior to the internal acoustic canal, resection was carried out through a retrosigmoid suprameatal approach with the patient in a semisitting position. Relevant anatomic and surgical considerations are discussed and illustrated in this 3-dimensional operative video. Gross total resection was achieved, and both patients remained neurologically intact and pain-free at long-term follow-up. Both patients consented to the procedure and to the publication of their image.

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Mortality and morbidity in surgically treated patients with petroclival meningiomas: a systematic review and meta-analysis of case series

Cited by 3 publications

References 84 publications

Postoperative Complications and Neurological Deficits After Petroclival Region Meningioma Resection: A Case Series

Postoperative Complications and Neurological Deficits After Petroclival Region Meningioma Resection: A Case Series

Surgical management of skull base meningiomas and vestibular schwannomas

Retrosigmoid Suprameatal Approach for the Resection of a Petrotentorial and a Petroclival Meningioma: 3-Dimensional Operative Video

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