Posterior fossa meningioma "our experience" in 64 cases

Abstract

Background:Posterior fossa meningiomas are 20% of all intracranial meningiomas. These are slow-growing tumors thus become large before presentation. Microsurgical resection is the treatment of choice for the majority of these lesions, but variable locations, large size at diagnosis, frequent encroachment of neural and vascular structures, and their potentially invasive behavior are some of the features of these tumors that make their resection challenging.Materials and Methods:We studied 64 cases of posterior fossa meningioma operated in last 6 years, and analysed the technical difficulties encountered during excision of these tumors. Postoperative complications and outcomes of these patients were also analysed.Results:Gross total excision was achieved in 72% cases. Partial excision or subtotal excision was more in petroclival, jugular foramen with extra cranial extension, tentorial with intrasinus extension and ventral foramen magnum. Postoperative complication in form of new or aggravation of existing neurological deficit was found in 33% cases and CSF leak in 12.5% cases. We encountered the recurrence of total 10 cases (16%) over mean follow-up of 4 years. Most of the recurrent cases were seen in petroclival and tentorial subgroups with partial or subtotal excision.Conclusion:Posterior fossa meningiomas are difficult to excise due to close relation to cranial nerves and vessels. Use of microscope, CUSA, intraoperative nerve monitor help in removal and preserving surrounding important anatomical structures. Although neurological deterioration is common postoperatively, recovery does occur completely after total removal thus increasing the recurrence free period and improving the outcome.

Petrous Face Meningiomas: Classification, Clinical Syndromes, and Surgical Outcomes

“…This is consistent with other reports that found hearing/vestibular dysfunction in 28% of patients, but facial weakness in only 8% of patients 18 . Lastly, the posterior petrous face tumors presented primarily with symptoms secondary to mass effect and/or hydrocephalus rather than focal deficits, consistent with others findings 19,20 . They were significantly associated with headaches, ataxia, vertigo and pre-operative hydrocephalus.…”

Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

“…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. 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 .…”

“…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 . Reported mortality differed markedly between authors, Guidetti et al .…”

Radiographic assessment of the presigmoid retrolabyrinthine approach

“…The presigmoid approach is also complicated by difficult dural closure, increased risk of spinal fluid leak, and increased risk of hearing loss. [ 13 26 29 ] With multiple reports that suggest the equivalence in achieving the surgical goals between presigmoid and retrosigmoid approaches in even the most complex petroclival pathology, the ideal approach for an individual lesion remains controversial particularly for those deemed accessible by both techniques. [ 6 16 17 20 25 27 ]…”