Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Meningiomas arising from the cavernous sinus (CS) continue to be a significant technical challenge, and resection continues to carry a relatively higher risk of neurological morbidity in patients with these lesions because of the tumor’s proximity to neurovascular structures. The authors report the surgical outcomes of 9 patients with primary CS meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This retrospective study included 9 patients who underwent surgery for CSM treatment between 2015 and 2016 via the MAPC transpetrosal approach. Two patients were men and 7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital craniotomy and exposure of the posterolateral part of the CS via the presigmoidal MAPC approach. After opening Meckel’s cave and identifying the 3rd–5th cranial nerves in the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened. Finally, the tumor occupying the posterolateral part of the CS was removed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>All lesions were safely and maximally removed, with preservation of external ocular movements and preoperative Karnofsky Performance Scale scores. The mean extent of resection was 77.0% (range 58.7%–95.4%). Six patients underwent adjuvant therapy in the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during the follow-up period; none of these patients experienced recurrence.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p>The authors conclude that the MAPC transpetrosal approach could be superior to other approaches for CSMs, as it provides direct visual access to the posterolateral portion of the CS. In their experience, this approach is an alternative and better option for safe maximal resection of CSMs.</jats:p></jats:sec>

Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

“…Chen et al described the pretemporal trans-cavernous, trans-Meckel’s, trans-tentorial trans-petrosal approach for addressing lesions extending from the cavernous sinus, Meckel’s cave, and optic foramen to the posterior fossa. This corridor tops up the incomplete view provided by the transsylvian avenue through a complete visualization of the middle fossa and pre-cavernous course of the cranial nerves, also freeing them from tentorial restrictions [ 234 ].…”

Visualization of Resected Area in Endonasal Endoscopic Approach versus Transcranial Approach for Skull Base Meningiomas by Voxel-Based-Lesion Mapping

“…Our strategy for SBMs has been to radically resect tumors with functional preservation. Several types of TCA for SBMs based on microsurgical anatomies have previously been reported [ 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. In addition, a report on a series of 161 consecutive cases of SBMs who underwent TCA suggests that radical resection could lead to excellent tumor control [ 8 ].…”

Identification of key genes of anti-programmed death ligand 1 for meningioma immunotherapy by bioinformatic analysis

“…For the management of meningiomas, maximal safe surgical resection remains the standard of treatment. However, the ability to achieve complete resection may be limited by a number of factors, including tumor location; involvement of nearby dural venous sinuses, arteries, cranial nerves, and brain invasion into eloquent tissue [24,24]. Recently, meningiomas are no longer considered as benign diseases.…”