Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

Abstract

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

Treatment experience of large intraventricular central neurocytoma: a retrospective cohort study

“…Most central neurocytomas show benign biological behavior, and patients can have a favorable prognosis when gross total tumor resection is achieved [9,10]. However, since aggressive surgical resection of tumors in deep brain areas may be associated with a high risk of damaging crucial neurovascular structures, it is important for surgeons to understand the natural history of central neurocytomas.…”

“…At the last follow-up visit, these three patients had no signs of tumor recurrence. However, in recent years, postoperative radiotherapy has been reported to have no effect on the overall survival rate of patients [17], and the delayed complications of radiotherapy, such as radiation necrosis, leukoencephalopathy, cognitive dysfunction and even radiationinduced malignant tumors, have received increasing attention in recent years [9]. No statistical correlation was found between radiotherapy and the tumor recurrence rate in this group of patients, but we found a signi cant statistical correlation between memory decline and radiotherapy (P = 0.017).…”

Transcortical approach for the treatment of large intraventricular central neurocytoma

“…Most central neurocytomas show benign biological behavior. If total tumor resection can be achieved, patients can obtain a good prognosis [9,10]. However, because most of the central neurocytomas are located in the ventricles of the brain, and the tumors are deep and adjacent to many important brain structures, the operation risk is high.…”

Treatment Outcome of Gamma Knife Radiosurgery for Petroclival Meningiomas: Retrospective Analysis of a Single Institution Experience

“…Even though most PCMs follow a benign clinical course, gross total resection (GTR) is considered the ideal treatment if possible. When GTR is not possible or postoperative complications are anticipated, the recent trend is to perform radiation treatment or radiosurgery by adjuvant treatment after subtotal resection [ 3 ]. In addition, Gamma Knife radiosurgery (GKRS) can be conducted as an initial alternative treatment for PCM, as in skull base meningiomas.…”

“…In addition, Gamma Knife radiosurgery (GKRS) can be conducted as an initial alternative treatment for PCM, as in skull base meningiomas. Although the effectiveness of adjuvant or alternative GKRS for PCM has already been demonstrated in several studies [ 3 4 5 6 7 8 ], the precise treatment guidelines have not yet been established.…”