Surgical Treatment Of Petroclival Meningiomas Research Articles

Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection: an analysis of 176 cases.

Purpose: The relationship of clinical results and survival analysis of operative patients with petroclival meningioma (PCM) was studied.Patients and methods: Data from a total of 176 PCM patients receiving surgical resection were retrospectively collected. Follow-up was conducted through outpatient review by reexamination telephone calls and letters. Clinical outcomes, survival, and Karnofsky Performance Scale (KPS) data were analyzed.Results: Seventy-two percent of patients (127/176) received only surgery, 8.5% (15/176) received surgery and adjuvant radiation therapy (RT) (surgery + RT), and 19.3% (34/176) received surgery and adjuvant gamma knife surgery (GKS) (surgery + GKS). Gross total resection (GTR) was performed in 34.7% of patients (61/176), subtotal resection (STR) in 58.0% (102/176), and partial resection (PR) in 7.4% (13/176). Recent follow-up KPS was higher than preoperative (80 vs 70, P<0.05) and postoperative KPS (80 vs 70, P<0.05). Cumulative survival was the same for 3, 5, 7, and 9 years, ie, 95%, and mean survival time (MST) was (110.83±2.55) months (95% CI: 105.83–115.83). Recurrence/progression (R/P)-free survival was 88.9%, 86.9%, 71.1% and 71.1%, respectively for 3, 5, 7, and 9 years, and MST was (100.58±3.82) months (95% CI: 93.11–108.06). R/P (HR: 5.486, 95% CI: 1.655–18.180), surgery + RT (HR: 0.125, 95% CI: 0.016–0.990) and WHO grade III (HR: 2.766, 95% CI: 1.146–6.676) were independently associated with cumulative survival. Lack of adhesion to and encasement of neurovascular structures was independently associated with R/P-free survival (HR: 2.002, 95% CI: 1.023–3.919).Conclusion: Surgical treatment was safe and effective for PCM. R/P, surgery + RT, and WHO grade III were independently associated with cumulative survival. Lack of adhesion to and encasement of neurovascular structures was independently associated with R/P-free survival. These factors should be paid attention to in surgical treatment of PCM.

Clinical analysis of preoperative embolization combined with Kawase approach in patients with petroclival meningioma

Objective: To investigate the effect of preoperative embolization combined with Kawase approach in the treatment of petroclival meningioma. Methods: Retrospective analysis of 15 cases of preoperative embolization combined with Kawase approach surgical treatment of petroclival meningioma, and 15 cases of patients without preoperative embolization were treated as controls. The surgical difficulty, intraoperative blood loss and operation time of two groups were tested. Result: The average blood loss of the preoperative embolization group was (315.52 ± 58.71 ml), the average blood transfusion was (185.35 ± 46.15 ml), the average operation time was (2.52 ± 0.59 h). The mean blood loss was (1136.25 ± 8.26 ml), and the average blood transfusion was (488.63 ± 62.32 ml), the average operation time was (5.15 ± 1.26 h) in the non-embolization group. The differences between the two groups were statistically significant (P<0.05). The degree of tumor resection in the preoperative embolization group was significantly higher than that in the non-embolization group. Conclusion: Preoperative embolization can significantly reduce intraoperative blood loss, operation time, and decrease the difficulty of Kawase approach surgery.

True Petroclival Meningiomas: Proposal of Classification and Role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine Approach

The evolution of the surgical treatment of petroclival meningiomas (PMs) has led to a tendency toabandon complex petrous approaches and return to "less-aggressive" skull base approaches. To propose a classification of PMs and establish the role of the combined supra-infratentorial presigmoid retrolabyrinthine (CSIPR) approach in the treatment of PMs rigorously matching the anatomical definition. A retrospective analysis was conducted of 51 cases of PMs strictly adhering to the anatomical definition who were operated on from January 1990 to December 2011. On the basis of the different patterns of growth from a common anatomical region of origin, a classification of PMs in 4 groups is proposed. Gross total resection was achieved in 32 patients (63%) and subtotal resection (at least 90% tumor volume removal) in 14 patients (27%). Each of the 4 groups of the proposed classification lends itself to be removed by a distinct surgical approach. Statistical analysis confirmed that such group-approach pairings significantly correlate with radical surgical removal (P < 0.001). Despite the high incidence of early postoperative complications, at late follow-up 82% of patients were free of significant postoperative neurological deficits (95% confidence interval: 70-90). Comparable neurological improvement was observed limited to cases treated by CSIPR (P= 0.60). For each PM group, the most suitable approach was identified in terms of surgical radicality and low postoperative morbidity. CSIPR can be considered the approach of choice for the most frequent group of PMs in our series. We believe that the CSIPR remains a valuable option for the treatment of PMs.

Keyhole approach surgery for petroclival meningioma

In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. The maximum diameter of tumors ranged from 2 to 7 cm (mean, 4.5 cm). Gross total resection (GTR) was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection (STR) was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits (VII, VII, III and lower CN). One patient died in the postoperative period. Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.

Clinical characteristics and results of surgical treatment of petroclival meningioma

The size of meningioma and its relation with neurovascular structures in petroclival region stipulate the degree of surgical radicalism and determine an operation risk. In spite of progress of surgical technology, the rate of surgical morbidity in view of cranial nerves deficit is 30%-50%. The objective of our study was to present the results of treatment of patients with petroclival meningiomas and to point to correlation of preoperative radiological findings and intraoperative results as well as neurological status of patients before and after surgical treatment. Retrospective analysis of 35 operated petroclival meningiomas at the Institute of Neurosurgery, CCS, in the period from 1995 to 2004 was presented. The following parameters were analyzed: size of tumor, relation with bone and neurovascular structures, preoperative condition, degree of surgical radicalism and postoperative outcome. The size of tumor was classified in four groups. There were 20 tumors at the right, and 15 at the left side. At the time of diagnostic procedures (based on CT and MRI), 20 tumors were in contact with brainstem, 9 compressed the brainstem, and 6 obstructed the IV ventricle. Preoperative patient condition was evaluated by Karnofsky index. Mean value for group I was 90, II - 80, III - 70 and IV - 50. In 9 cases, liquor drainage was performed preoperatively. In 3 cases, external liquor drainage was carried out postoperatively, and in one case it was replaced by permanent liquor drainage. Radical operation was performed in 44%, and significant reduction was done in other cases. In the postoperative period, 11% patients died, 28% had cranial nerves deficit, and pyramid deficit was recorded in 14% of the patients. The tumor size (III-IV) and brainstem compression were found to be statistically significant (p<0.05) as predisposed factors of deficit prolongation. Petroclival meningoma surgery is required upon precise preoperative analysis. Radicalism of operation is reserved for small and medium tumors, younger patients, and patients in good preoperative condition

Gamma knife radiosurgical management of petroclival meningiomas results and indications.

Surgical treatment of petroclival meningiomas remains challenging. In order to refine indications for the use of stereotactic radiosurgery in the treatment of these tumours, we retrospectively evaluated our experience in this field. Thirty-two patients harboring a petroclival meningioma were treated consecutively using a Gamma knife between December 92 and June 1998. Eight patients underwent radiosurgery after one or more attempted surgical removals and 24 had radiosurgery as the primary treatment. The main symptoms before radiosurgery were cranial nerve palsies, including a sixth nerve deficit in 10 patients and a trigeminal nerve disturbance in 9. All patients underwent a conformal multi-isocentric treatment (mean isocenter's number 8.8) and the dose delivered at the tumour margin ranged from 10 to 15 Gy (mean dose 13 Gy). The duration of follow-up varied from 24 to 118 months (mean clinical follow-up 56 months, mean radiological follow-up 52.6 months). All 32 patients survived. The tumour volume remained unchanged in 28 patients and decreased slightly in 4. Neurological status worsened permanently in 2 patients with a delayed hemiparesis due to focal pontine infarction. These complications were associated with large meningiomas with vascular involvement and ventral brainstem compression, and occurred at the very early stage of our experience. At last follow-up, preoperative fifth or sixth cranial nerve deficits had improved or recovered in 13 out of 19 patients and any delayed worsening or new cranial nerve deficits were not observed after radiosurgery. Stereotactic radiosurgery with a Gamma knife provides effective management of small to middle sized petroclival meningiomas and is an alternative to microsurgery. Careful selection of patients and use of major technical refinements should improve the safety of this treatment.

Surgical treatment of petroclival meningioma with special reference to timing of radiosurgery for residual tumor

Introduction: To avoid any morbidity occurring by the surgery for petroclival meningioma, our treatment strategy is (1) the tumor should be left undetached in the case there is no CSF space between tumor and the surrounding structures, to avoid new deficit, (2) the residual volume should be reduced to less than 20 ml, that is, small enough for radiosurgery. The result of our strategy will be presented. Methods: During the past 5 years, we have experienced 13 patients with petroclival meningioma. The tumor volume ranges from 1.0 to 70 ml. Eight patients had neurological deficits preoperatively. Ten patients underwent the anterior petrosal approach while two patients underwent the far lateral approach, according to the tumor attachment. Results: The tumors were totally removed in five patients. The surgical removal had successfully decreased the tumor size in eight patients. The residual volume was small enough (less than 20 ml) just after the surgical removal in each case. Thus, the radiosurgery followed within 3 months after the open surgery in six patients. The residual tumor has almost disappeared in one case and decreased in five cases. No new deficit occurred other than a transient facial weakness in one case and an oculomotor palsy in the other. Conclusion: It is concluded that our planned surgical treatment of the petroclival meningioma is safe and sure in terms of the patients' quality of life. The planned radiosurgery for the residual tumor immediately after the surgical removal is considered most effective.

Surgical treatment of petroclival meningiomas: Experience with 16 cases

This article presents the surgical results in a series of 16 petroclival meningiomas operated on from 1984–1990. Tumors with marked infiltration of the cavernous sinus, which belong to the category of spheno-petro-clival meningiomas, were excluded. The 16 petroclival meningiomas were all surgically treated using the combined transmastoid temporosuboccipital approach that offers a number of possible variants: retrosigmoidal, with or without recision of the sinus; presigmoidal retro-, or translabyrinthine. The choice of one or another of these variants depends on certain clinical (preoperative hearing status) and anatomic (size and extension, central or lateral, of the tumor; patency of the transverse sinuses; size and position, more or less anterior, of the sigmoid sinus; position, more or less high, of the jugular bulb) factors. The principle indications for each of these approaches are given with particular emphasis on their relative advantages and limitations