Proposed Grading System to Predict the Extent of Resection and Outcomes for Cranial Base Meningiomas

Levine, Zachary T.; Buchanan, Russell I.; Sekhar, Laligam N.; Rosen, Charles L.; Wright, Donald C.

doi:10.1097/00006123-199908000-00003

Cited by 84 publications

(50 citation statements)

References 30 publications

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“…Attempts have been made to assess preoperatively the likelihood of complications and extent of resection in order to guide treatment. 3,20,21,35 Cavernous sinus extension did not adversely affect the extent of resection in this series, as GTR was performed in 37 of 39 cases. This feature should not deter surgeons from the pursuit of total resection.…”

Section: Surgery: Extent Of Resectionmentioning

confidence: 70%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

131

121

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Object The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. Methods The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O.A.) from 1988 to 2012, strictly defined as those originating medial to the fifth cranial nerve on the upper two-thirds of the clivus. The patients' average age was 49 years; the average tumor size (maximum diameter) was 35.48 ± 10.09 mm (with 59 tumors > 20 mm), and cavernous sinus extension was present in 39 patients. The mean duration of follow-up was 71.57 months (range 4–276 months). Results In 42 patients, the operative reports allowed the grading of resection. Grade I resection (tumor, dura, and bone) was achieved in 17 patients (40.4%); there was no recurrence in this group (p = 0.0045). Grade II (tumor, dura) was achieved in 15 patients (36%). There was a statistically significant difference in the rate of recurrence with respect to resection grade (Grades I and II vs other grades, p = 0.0052). In all patients, tumor removal was classified based on postoperative contrast-enhanced MRI, and gross-total resection (GTR) was considered to be achieved if there was no enhancement present; on this basis, GTR was achieved in 41 (64%) of 64 patients, with a significantly lower recurrence rate in these patients than in the group with residual enhancement (p = 0.00348). One patient died from pulmonary embolism after discharge. The mean Karnofsky Performance Status (KPS) score was 85.31 preoperatively (median 90) and improved on follow-up to 88, with 30 patients (47%) having an improved KPS score on follow-up. Three patients suffered a permanent deficit that significantly affected their KPS. Cerebrospinal fluid leak occurred in 8 patients (12.5%), with 2 of them requiring exploration. Eighty-nine percent of the patients had cranial nerve deficits on presentation; of the 54 patients with more than 2 months of follow-up, 21 (32.8%) had persisting cranial nerve deficits. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6.2%. There was no difference with respect to immediate postoperative cranial nerve deficit in patients who had GTR compared with those who had subtotal resection. Conclusions Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.

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Section: Surgery: Extent Of Resectionmentioning

confidence: 70%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

131

121

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“…All patients were Levine-Sekhar grade 1 [13,14] . Two patients had tumors without compression of the brain stem, and the trigeminal nerve was identifiable in both.…”

Section: Patient Populationmentioning

confidence: 99%

Stereotactic Radiosurgery for Patients with Trigeminal Neuralgia Associated with Petroclival Meningiomas

Kano

Awan²,

Flannery

et al. 2010

Stereotact Funct Neurosurg

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Background:The management of trigeminal neuralgia in patients with associated skull base meningiomas is complex. Objective:We evaluated the pain management needs and outcomes in patients with petroclival meningiomas associated with medically refractory trigeminal neuralgia. Methods: During a 21-year period, 168 patients underwent stereotactic radiosurgery (SRS) for meningiomas involving the petroclival region. We identified 12 patients (10 females; median age 54 years) who had trigeminal neuralgia in association with an ipsilateral petroclival meningioma. The median tumor volume was 3.8 cm³ (1.0–15.9 cm³). The median prescription dose for tumor margins was 13 Gy (11–16 Gy). Results: Initial pain control [Barrow Neurological Institute (BNI) grades I–IIIb] was obtained in 10 of 12 patients (83%). However, 3 patients with initial adequate relief later developed pain. Follow-up imaging revealed control of tumor growth in all patients at a median follow-up of 68 months. No patient developed any new sensory dysfunction. The tumor shrinkage was not associated with pain relief. At the final follow-up, 5 patients had pain of BNI grade I (2 after surgery), 4 had grade IIIb and 3 had grade IV. Conclusions: SRS provided effective tumor control, but trigeminal neuralgia persisted to varying degrees in most patients. Multimodality pain management strategies were required in most patients with skull base meningiomas associated with trigeminal neuralgia.

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“…Simpson 3-6) (33,45,48,52,53,75,80). This seems particularly true in the vast majority of convexity meningiomas, whereas results are less warranted in critical locations, like in skull base tumors.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Considering some of the largest published series, gross total removal of basal meningiomas sounds achievable in 60%-87.5% of the patients with 30%-56% of severe complications -particularly frequent in grade 2-3 histotypes -and a median postoperative mortality rate of 3.6 % (0%-9%) (11,12,45,48,75,76,79,80). The main factors conditioning the extent of removal in skull base locations have been extensively analyzed in the literature, thereby creating the "resectability grading" where the final score represents the sum of each of the most relevant limiting factors: from cranial nerve involvement to vessel encasement, from extrafossa invasion to previous radiation treatments (45,63,74,78,82,86). The observed wide spectrum of recurrence rates (from 0 to 17%), is seemingly linked not only to the pre-existing W.H.O.…”

Section: Treatment Optionsmentioning

confidence: 99%