Petroclival meningiomas: study on outcomes, complications and recurrence rates

Nanda, Anil; Javalkar, Vijayakumar; Banerjee, Anirban

doi:10.3171/2010.11.jns10326

Cited by 119 publications

(110 citation statements)

References 49 publications

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“…2,3,5,11,15) Furthermore, the present series provides long-term follow-up results (more than 10 years) of patients with posterior cranial base meningiomas. The present results support our strategy of treatment of patients with these meningiomas.…”

Section: Discussionmentioning

confidence: 99%

“…This is remarkably better than results reported others. [2][3][4][5]11,15) In this series, I have never experienced postoperative intractable CSF leakage, due to tight dural closure using temporal muscle fascia and/or abdominal fat. If necessary, patients were treated by lumbar drainage.…”

Section: Tumor Resection and Separation From Neurovascular Structmentioning

confidence: 99%

“…These results are extremely good compared to previously reported results. [2][3][4][5]11,15) VII. Postoperative management At a timepoint of one year after surgery, only two patients showed Karnofsky performance status deterioration.…”

Section: Tumor Resection and Separation From Neurovascular Structmentioning

confidence: 99%

“…11,16) In this review, I will describe and discuss my strategy of surgical treatment and operative results of meningiomas located in the posterior cranial fossa including the cranio-vertebral junction but excluding the jugular foramen which I have experienced over about 20 years.…”

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confidence: 99%

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Therapeutic Strategy and Long-term Outcome of Meningiomas Located in the Posterior Cranial Fossa

Matsui

2012

Neurol. Med. Chir.(Tokyo)

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The clinical and surgical findings of 41 consecutive cases of posterior cranial fossa meningiomas operated on between January 1987 and December 2011 at Saitama Medical Center/Saitama Medical University were reviewed. The 31 female and 10 male patients were aged from 19 to 74 years (mean 54 years). The tumors were located in the petroclival (N ＝ 15), craniovertebral junction (N ＝ 6), lateral tentorial (N ＝ 12), and cerebellopontine angle (N ＝ 8) regions. Mean tumor equivalent diameter was 4.3 cm (range 2-9 cm). Head pain (46.3%) and gait disturbance (26.8%) were the most common presenting symptoms, and cranial neuropathies were the most common neurological signs on admission. Mean preoperative performance status (Karnofsky scale) was 83% (range 40-100%). Surgical approaches to these tumors included presigmoidal transpetrosal, retrosigmoidal, transcondylar, and combined approaches. In 4 cases, a staged procedure was performed. Gross total resection was achieved in 85.4% of patients, and subtotal/partial resection in 12.2%. Surgical mortality was 2.4% and complications were encountered in 11 patients (26.8%) including temporary neurological deficits in 4 patients. The mean follow-up period was 8.2 years, ranging from 1 to 24 years, and the mean performance status of patients at 12 months after the last surgery was 92% (range 0-100%). Recurrence or progression of disease was found in 9.8% of cases. Postoperative adjuvant therapy was performed in 6 cases. My experience suggests that although posterior cranial fossa meningiomas represent a continuing challenge for contemporary neurosurgeons, such tumors may be completely or subtotally removed with low rate of mortality and acceptable morbidity, allowing most of these patients to achieve good outcome in long-term follow up.

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Section: Discussionmentioning

confidence: 99%

Section: Tumor Resection and Separation From Neurovascular Structmentioning

confidence: 99%

Section: Tumor Resection and Separation From Neurovascular Structmentioning

confidence: 99%

mentioning

confidence: 99%

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Therapeutic Strategy and Long-term Outcome of Meningiomas Located in the Posterior Cranial Fossa

Matsui

2012

Neurol. Med. Chir.(Tokyo)

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“…Permanent surgical morbidity remained in 20 % of patients during the average long-term follow-up of almost 10 years, but significantly more patients lived independently after than before surgery (61 vs 46 %). One-fourth of patients were lost to longterm follow-up, so that the numbers regarding long-term outcome must be appreciated with sound judgment.These key data focusing on medium and large petroclival meningioma are important, although difficult to compare with the smaller unselected series [1,3,[7][8][9]12]. Petroclival meningiomas smaller than 2 cm carry a much smaller surgical risk than large tumours, and in unselected series the small tumours dilute information regarding the problematic larger tumours.…”

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confidence: 99%

Surgical management of medium and large petroclival meningiomas: benchmark and limits

Steiger

2016

Acta Neurochir

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Da Li and co-workers present a detailed sub-analysis of their series of petroclival meningiomas, which is the largest monocentric series published to date [5,6]. In the current work, they restrict the analysis to medium and large tumours of more than 2 cm in diameter-the tumours that really cause difficulties for microsurgery as well as stereotactic radiosurgery. Gross total resection was achieved in 56 % of patients; dysfunctions of the cranial nerves were the most common complication and occurred in two-thirds of the patients. Immediately following surgery, morbidity temporarily increased and the Karnovsky Performance Scale temporarily decreased on average. The case fatality rate amounted to 2 %. Permanent surgical morbidity remained in 20 % of patients during the average long-term follow-up of almost 10 years, but significantly more patients lived independently after than before surgery (61 vs 46 %). One-fourth of patients were lost to longterm follow-up, so that the numbers regarding long-term outcome must be appreciated with sound judgment.These key data focusing on medium and large petroclival meningioma are important, although difficult to compare with the smaller unselected series [1,3,[7][8][9]12]. Petroclival meningiomas smaller than 2 cm carry a much smaller surgical risk than large tumours, and in unselected series the small tumours dilute information regarding the problematic larger tumours. Numbers for the rate of gross total resection and surgical morbidities given in the published unselected series differ widely: gross total resection between one-third and twothirds, and surgical morbidity also between one-third and twothirds.Stereotactic radiosurgery is an obvious alternative for primary treatment of these tumours. There are not very many reports-a fact that reflects concerns regarding tolerance in view of the vicinity of the brainstem. The Pittsburgh group reported their experience in a series of 39 patients with a median follow-up period of 37 months. Neurological status improved in 21 %, remained stable in 66 %, and eventually worsened in 13 %. Tumour volumes decreased in 23 %, remained stable in 68 % and increased in 8 % [13]. It appears that there is some kind of consensus that radiosurgery is an adjuvant modality for larger petroclival meningiomas, which cannot be recommended as first-line therapy. However, there is little doubt that in analogy to vestibular schwannomas, stereotactic radiosurgery has evolved to an alternative for smallsized meningiomas.The substantial proportion of incomplete removal in most series and the significant rate of morbidity suggest that petroclival meningiomas remain not only difficult but basically problematic for microsurgery. Finding the balance between radicality and risk is the real challenge of managing petroclival meningiomas. The surgical risk appears to be influenced by (1) tumour size, (2) consistency and texture of the tumour and (3) the interface between tumour and arteries, brainstem and cranial nerves. In my opinion, it is hardly possible to disse...

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Petroclival meningiomas: study on outcomes, complications and recurrence rates

Cited by 119 publications

References 49 publications

Therapeutic Strategy and Long-term Outcome of Meningiomas Located in the Posterior Cranial Fossa

Therapeutic Strategy and Long-term Outcome of Meningiomas Located in the Posterior Cranial Fossa

Surgical management of medium and large petroclival meningiomas: benchmark and limits

ICAR: endoscopic skull‐base surgery

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