1
|
Shkarubo AN, Chernov IV, Veselkov AA, Andreev DN, Yakupova ZF, Kalinin PP. [Endoscopic transnasal resection of clival meningiomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:105-111. [PMID: 38549417 DOI: 10.17116/neiro202488021105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Surgical treatment of ventral and ventrolateral meningiomas of posterior cranial fossa is difficult in modern neurosurgery. This is due to peculiarities of approach to these areas and concentration of critical structures (cranial nerves and great vessels). Currently, endoscopic transnasal approach to these meningiomas allows partial, and in some cases, total resection. However, this technique is not widespread. OBJECTIVE To analyze the world literature data on postoperative outcomes in patients with clival and petroclival meningiomas after endoscopic transnasal resection. MATERIAL AND METHODS We analyzed 22 articles representing treatment of 61 patients with clival and petroclival meningiomas. RESULTS Total or near-total resection was achieved in 22.9% of cases, subtotal resection - 40.9%, partial resection - 26.2% (data were not provided in other cases). Even partial and subtotal resection leads to significant regression of symptoms. CONCLUSION Endoscopic transnasal surgery is a full-fledged alternative to transcranial approaches in surgical treatment of clival meningiomas. It is also an additional option for patients with petroclival meningiomas after ineffective transcranial approaches. Transnasal tumor shrinkage and devascularization lead to brainstem decompression, regression of hydrocephalus and baseline clinical symptoms.
Collapse
Affiliation(s)
| | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
| | - Z F Yakupova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - P P Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
| |
Collapse
|
2
|
Pattankar S, Misra BK. Treatment Strategies and Current Results of Petroclival Meningiomas. Adv Tech Stand Neurosurg 2023; 48:251-275. [PMID: 37770687 DOI: 10.1007/978-3-031-36785-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Petroclival meningiomas (PCMs) are complex skull-base tumors that continue to pose a formidable surgical challenge to neurosurgeons because of their deep-seated location/intimate relationship with the brainstem and neurovascular structures. The advent of stereotactic radiosurgery (SRS), along with the shifting of management goals from complete radiological cure to maximal preservation of the patient's quality of life (QOL), has further cluttered the topic of "optimal management" in PCMs. Not all patients with PCM need treatment ("watchful waiting"). However, many who reach the neurosurgeons with a symptomatic disease need surgery. The goal of the surgery in PCMs is a GTR, yet this can be achieved in only less than half of the patients with acceptable morbidity. The remainder of the patients are better treated by STR followed by SRS for residual tumor control or close follow-up. A small subset of patients with PCM may be best treated by primary SRS. In this chapter, we have tried to summarize the scientific evidence pertaining to the management of PCMs (including the senior author's series), particularly those regarding the available treatment strategies and current outcomes, and discuss the decision-making process to formulate an "optimal management" plan for individual PCMs.
Collapse
Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery and Gamma Knife Radiosurgery, P D Hinduja Hospital and MRC, Mumbai, India
| | - Basant K Misra
- Department of Neurosurgery and Gamma Knife Radiosurgery, P D Hinduja Hospital and MRC, Mumbai, India.
| |
Collapse
|
3
|
Eryi S, Bo C, Tairong W, Hua Y. Contralateral sudden sensorineural hearing loss after resection of petroclival meningioma using combined supra- and infratentorial approach surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
4
|
Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M, Meling TR, Berhouma M, Cossu G, Cornelius JF, Paraskevopoulos D, Zazpe I, Jouanneau E, Cavallo LM, Benes V, Seifert V, Tatagiba M, Schroeder HWS, Goto T, Ohata K, Al-Mefty O, Fukushima T, Messerer M, Daniel RT, Froelich S. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section. Acta Neurochir (Wien) 2021; 163:1639-1663. [PMID: 33740134 DOI: 10.1007/s00701-021-04798-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
Collapse
Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - D Starnoni
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - T R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - M Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - G Cossu
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - D Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - I Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - L M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy
| | - V Benes
- Department of Neurosurgery, First Medical Faculty, Military University Hospital and Charles University, Prague, Czech Republic
| | - V Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - H W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - O Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Fukushima
- Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, NC, USA
| | - M Messerer
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| |
Collapse
|
5
|
Eryi S, Hua Y, Tairong W, Bo C. Contralateral sudden sensorineural hearing loss after resection of petroclival meningioma. Laryngorhinootologie 2021; 100:467-471. [PMID: 33823561 DOI: 10.1055/a-1463-3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sun Eryi
- The first people hospital, Zhenjiang Jiangsu, China
| | - Yang Hua
- Guizhou Medical University, Guizhou Guiyang, China
| | - Wu Tairong
- The first people hospital, Zhenjiang Jiangsu, China
| | - Chen Bo
- The first people hospital, Zhenjiang Jiangsu, China
| |
Collapse
|
6
|
Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. Acta Neurochir (Wien) 2020; 162:2097-2109. [PMID: 32556526 DOI: 10.1007/s00701-020-04451-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical approaches to the petrous apex region are extremely challenging; while subtemporal approaches and variations represent the milestone of the surgical modules to reach such deep anatomical target, in a constant effort to develop minimally invasive neurosurgical routes, the endoscopic endonasal approach (EEA) has been tested to get a viable corridor to the petroclival junction. Lately, another ventral endoscopic minimally invasive route, i.e., the superior eyelid endoscopic transorbital approach, has been proposed to access the most lateral aspect of the skull base, including the petrous apex region. Our anatomic study aims to compare and combine such two endoscopic minimally invasive pathways to get full access to the petrous apex. Three-dimensional reconstructions and quantitative and morphometric data have been provided. MATERIAL AND METHODS Five human cadaveric heads (10 sides) were dissected. The lab rehearsals were run as follows: (i) preliminary pre-operative CT scans of each specimen, (ii) pre-dissection planning of the petrous apex removal and its quantification, (iii) petrous apex removal via endoscopic endonasal route, (iv) post-operative CT scans, (v) petrous apex removal via endoscopic transorbital route, and (v) final post-operative CT scan with quantitative analysis. Neuronavigation was used to guide all dissections. RESULTS The two endoscopic minimally invasive pathways allowed a different visualization and perspective of the petrous apex, and its surrounding neurovascular structures. After both corridors were completed, a communication between the surgical pathways was highlighted, in a so-called connection area, surrounded by the following important neurovascular structures: anteriorly, the internal carotid artery and the Gasserian ganglion; laterally, the internal acoustic canal; superiorly, the abducens nerve, the trigeminal root, and the tentorium cerebelli; inferomedially, the remaining clivus and the inferior petrosal sinus; and posteriorly, the exposed area of the brainstem. Used in a combined fashion, such multiportal approach provided a total of 97% of petrous apex removal. In particular, the transorbital route achieved a mean of 48.3% removal in the most superolateral portion of the petrous apex, whereas the endonasal approach provided a mean of 48.7% bone removal in the most inferomedial part. The difference between the two approaches was found to be not statistically significant (p = 0.67). CONCLUSION The multiportal combined endoscopic endonasal and transorbital approach to the petrous apex provides an overall bone removal volume of 97% off the petrous apex. In this paper, we highlighted that it was possible to uncover a common path between these two surgical pathways (endonasal and transorbital) in a so-called connection area. Potential indications of this multiportal approach may be lesions placed in or invading the petrous apex and petroclival regions that can be inadequately reached via transcranial paths or via an endonasal endoscopic route alone.
Collapse
|
7
|
Mansour S, Luther E, Echeverry N, McCarthy D, Eichberg DG, Shah A, Matus A, Chen S, Gultekin SH, Ivan M, Morcos J. Rare Tumor-to-Tumor Metastases Involving Lung Adenocarcinoma to Petroclival Meningiomas. World Neurosurg 2020; 144:125-135. [PMID: 32730974 DOI: 10.1016/j.wneu.2020.07.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lung carcinoma metastasizing to a skull base meningioma remains an extremely rare phenomenon, with only 3 studies reported. Furthermore, no documented cases have been reported in the petroclival region. Thus, we have presented the first 2 cases of tumor-to-tumor metastasis (TTM) in which a petroclival lesion, initially thought to be purely meningioma, was also found to contain metastatic lung adenocarcinoma. CASE DESCRIPTION We present the cases of 2 patients with a known history of lung adenocarcinoma and stable petroclival meningioma who had presented with new-onset neurologic deficits. Repeat imaging studies for both patients found an increased lesion size and peritumoral enhancement; thus, both patients underwent emergent craniotomy for complete lesion resection. Intraoperatively, both lesions had zones of markedly different tumoral texture. On histologic analysis, both lesions showed metastatic lung adenocarcinoma contained within the primary petroclival meningioma. CONCLUSION Skull base TTM is a rare entity for which no specific management guidelines have been created. Therefore, even if the imaging characteristics suggest a more benign process, skull base TTM should remain high on the differential diagnosis for patients with a known primary cancer and new-onset, rapidly progressive, neurologic deficits. Close clinical follow-up with short-interval repeat imaging in this subset of patients might prevent misdiagnosis and facilitate prompt treatment.
Collapse
Affiliation(s)
- Samuel Mansour
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nikolas Echeverry
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - David McCarthy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alejandro Matus
- Department of Neurological Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Stephanie Chen
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sakir Humayun Gultekin
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques Morcos
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
8
|
Electrophysiological predictors of hearing deterioration based on AEP monitoring during petroclival meningioma resection. Neurosurg Rev 2020; 44:1601-1609. [PMID: 32671694 DOI: 10.1007/s10143-020-01350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study was to calculate the risk of postsurgical hearing deterioration as a function of changes in the amplitude and latency of the most stable components (waves III and V) of the auditory evoked potential (AEP) during petroclival meningioma resection surgery. We retrospectively analyzed intraoperative AEP monitoring results and pre- and postsurgical hearing status in 40 consecutive patients who were surgically treated for petroclival meningiomas. Statistical analyses were conducted to identify the most sensitive and specific way to predict hearing dysfunction after surgery. Patients' mean age was 59 ± 10 years, and 31 (77.5%) were women. Twelve (30%) patients presented with clinically detectable hearing impairment preoperatively. At the first postoperative assessment, four of those 12 patients reported subjective improvement, and eight reported hearing deterioration. Of those eight, four remained stable and four recovered hearing by the last assessment. Wave III latency reached its highest specificity (100%) and sensitivity (71.43%) at x = 143%. Wave V latency, on the other hand, reached its highest sensitivity (71%) and specificity (93%) at x = 124%. Finally, wave V amplitude reached its highest sensitivity (100%) and specificity (79%) at x = 74%. Intraoperative alterations of wave III latency and wave V amplitude seem to be highly sensitive and specific at predicting the risk of auditory dysfunction in patients undergoing petroclival meningioma resection and should be used to determine maximum resection with preservation of function.
Collapse
|
9
|
Kim JW, Jung HW, Kim YH, Park CK, Chung HT, Paek SH, Kim DG, Lee SH. Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution. J Neurosurg 2020; 132:1675-1682. [PMID: 31075775 DOI: 10.3171/2019.2.jns182604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution. METHODS Ninety-two patients with petroclival meningiomas were treated surgically at the authors' institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1-368 months) and 105 months (range 1-348 months), respectively. RESULTS A posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively. CONCLUSIONS The authors' preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.
Collapse
Affiliation(s)
- Jin Wook Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Hee-Won Jung
- 2Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong Hwy Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Hyun-Tai Chung
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Sun Ha Paek
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Dong Gyu Kim
- 1Department of Neurosurgery, Seoul National University Hospital; and
| | - Sang Hyung Lee
- 2Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
10
|
Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Shimanskiy VN, Karnaukhov VV, Galkin MV, Tanyashin SV, Golanov AV, Poshataev VK, Shevchenko KV. [Treatment of petroclival meningiomas: current state of the problem]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:78-89. [PMID: 32031171 DOI: 10.17116/neiro20198306178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Petroclival meningiomas (PCMs) are benign, slowly growing tumors. Surgery still remains the main treatment option for them. The desire for total resection of large extended PCMs often leads to the development or worsening of persistent neurological deficits. This paper presents a review of the world literature devoted to petroclival meningiomas. We discuss the issues of PCM classification, biology, diagnosis, and selection of the optimal algorithm for their treatment.
Collapse
Affiliation(s)
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | |
Collapse
|
12
|
Petroclival Meningioma Presenting With an Ipsilateral Sixth Nerve Palsy and a Contralateral Homonymous Quadrantanopia: A Unique and Topographically Localizing Syndrome. J Neuroophthalmol 2019; 39:405-407. [DOI: 10.1097/wno.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Qiao L, Yu C, Zhang H, Zhang M, Qu Y, Ren M, Gu C, Wang H. Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection: an analysis of 176 cases. Cancer Manag Res 2019; 11:5949-5959. [PMID: 31308738 PMCID: PMC6612996 DOI: 10.2147/cmar.s200932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/05/2019] [Indexed: 12/01/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Li Qiao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, Gansu Provincial Hospital, Lanzhou, Gansu Province, People's Republic of China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongwei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mingshan Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanming Qu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Ren
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunyu Gu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Haoran Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
14
|
Matulevicius V, Urbanavicius V, Lukosevicius S, Ciaplinskiene L, Ostrauskas R. THE RARE CASE OF MIXED GONADAL DYSGENESIS, MOSAIC KARYOTYPE, PETROCLIVAL MENINGIOMA AND IDIOPATHIC HYPERDEHYDROEPIANDROSTERONISM. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 14:527-532. [PMID: 31149308 DOI: 10.4183/aeb.2018.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Mosaic karyotype 45,X/46,XY related mixed gonadal dysgenesis. Aim To report a case of mosaic karyotype and petroclival meningioma. Methods Presentation of a clinical case with comments. Results The case of a 37-year-old woman mosaic karyotype - 45,X/46,XY, infertility, virilisation, Turner syndrome-like phenotype, primary amenorrhea, the absence of labia majora and petroclival meningioma. Concentrations of dehydroepiandrosterone sulphate (DHEAS), testosterone, luteinizing hormone (LH) and follicular stimulating hormone (FSH) were increased indicating hypergonadotropic hypogonadism. Low and high dose dexamethasone suppression tests demonstrated incomplete suppression of DHEAS concentration without connection between pulses of LH/FSH and DHEAS. Response to adrenocorticotropic hormone (ACTH) was normal. The morning/evening concentration ratio of DHEAS was very low in comparison with cortisol, ACTH and testosterone. Head magnetic resonance imaging (MRI) demonstrated petroclival meningioma without any adrenal or ovary abnormality. Menstruation started after treatment with 2 mg of estradiol. At control visit 1.5 years later she had no complaints. MRI did not demonstrate any signs of tumour progression. Conclusions The main lesson learned from this case is that in searching the DHEAS secreting tumours one can find unusual cases with sustained high DHEAS and lack of confirmations of polycystic ovary syndrome, adrenal or ovary tumours using available ultrasound, CT and MRI.
Collapse
Affiliation(s)
- V Matulevicius
- Lithuanian University of Health Sciences - Institute of Endocrinology, Lithuania
| | - V Urbanavicius
- Lithuanian University of Health Sciences - Vilnus University, Faculty of Medicine, Vilnus, Lithuania
| | - S Lukosevicius
- Lithuanian University of Health Sciences - Department of Radiology, Kaunas, Lithuania
| | - L Ciaplinskiene
- Lithuanian University of Health Sciences - Institute of Endocrinology, Lithuania
| | - R Ostrauskas
- Lithuanian University of Health Sciences - Institute of Endocrinology, Lithuania
| |
Collapse
|
15
|
Nicosia L, Pietro SD, Catapano M, Spadarella G, Sammut L, Cannataci C, Resta F, Reganati P. Petroclival meningiomas: radiological features essential for surgeons. Ecancermedicalscience 2019; 13:907. [PMID: 31123490 PMCID: PMC6445566 DOI: 10.3332/ecancer.2019.907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Indexed: 12/23/2022] Open
Abstract
Petroclival meningiomas (PCMs) have always been a challenge for surgeons because of their difficult anatomical location. The role of radiology in providing precise indications regarding the tumour site and aggressiveness plays a major part in guiding the subsequent therapeutic process. The purpose of this review is to provide a set of the main radiological features helpful in the management of PCMs towards the most correct therapeutic approach. We aim to offer a radiological overview to allow the patient to be directed to surgery with the least possible risk of complications.
Collapse
Affiliation(s)
- Luca Nicosia
- Breast Radiology Department, European Institute of Oncology, 2014, Via G Ripamonti 435, Milano, Italy.,Luca Nicosia and Salvatore Di Pietro contributed equally and share first-authorship
| | - Salvatore Di Pietro
- Breast Radiology Department, European Institute of Oncology, 2014, Via G Ripamonti 435, Milano, Italy.,Luca Nicosia and Salvatore Di Pietro contributed equally and share first-authorship
| | - Michele Catapano
- Breast Radiology Department, European Institute of Oncology, 2014, Via G Ripamonti 435, Milano, Italy
| | - Gaia Spadarella
- Breast Radiology Department, European Institute of Oncology, 2014, Via G Ripamonti 435, Milano, Italy
| | - Lara Sammut
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD 2090 Msida, Malta
| | - Christine Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD 2090 Msida, Malta
| | - Federico Resta
- Neuroradiology Unit, San Giuseppe Hospital, Milano Via San Vittore 12, 20123 Milano, Italy
| | - Paolo Reganati
- Neuroradiology Unit, San Giuseppe Hospital, Milano Via San Vittore 12, 20123 Milano, Italy
| |
Collapse
|
16
|
Ding Z, Lu X, Wang Q, Li B, Qian X, Liu X. Intradural Subtemporal Keyhole Approach with Neuronavigational Assistance to the Petroclival and Ventrolateral Brainstem Regions: Quantitative Analysis of Anatomic Exposure and Surgical Freedom. World Neurosurg 2019; 124:e682-e692. [PMID: 30659968 DOI: 10.1016/j.wneu.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the advantages of endoscopy and navigational assistance in the intradural subtemporal keyhole approach and the intradural Kawase approach by studying anatomic exposure and surgical freedom in the posterior cranial fossa. METHODS Twenty endoscopic intradural subtemporal keyhole approaches (EISKA) were performed on 10 cadaveric heads. An intradural Kawase approach and a navigation-assisted intradural Kawase approach were then carried out on a random side of each specimen. Related anatomic structures were observed through a 0° endoscope and a microscope. Anatomic exposure and surgical freedom were measured by transparent graph paper and analyzed. RESULTS Compared with the microsurgical technique, the superior, inferior, and medial limits of the endoscopic anatomic exposure increased by 2.9, 15.65, and 10.2 mm, whereas the surgical freedom increased by 2.9, 7.55, and 6 mm (P < 0.05) in the intradural subtemporal keyhole approach. In the intradural Kawase approach and the navigation-assisted intradural Kawase approach, the endoscopic anatomic exposure and surgical freedom also increased (P < 0.05). Using a frameless navigational device, the inferior limit of the anatomic exposure increased 3.8 mm by endoscopy and 3.5 mm by microscopy, whereas the surgical freedom increased by 2.7 and 2.2 mm, respectively (P < 0.05). CONCLUSIONS The EISKA provides greater anatomic exposure and surgical freedom primarily in the superior, inferior, and medial directions of the brainstem region. Maximum anatomic exposure and surgical freedom of the posterior cranial fossa was obtained by navigational assistance with fewer complications.
Collapse
|
17
|
Di Somma A, Andaluz N, Cavallo LM, Topczewski TE, Frio F, Gerardi RM, Pineda J, Solari D, Enseñat J, Prats-Galino A, Cappabianca P. Endoscopic transorbital route to the petrous apex: a feasibility anatomic study. Acta Neurochir (Wien) 2018; 160:707-720. [PMID: 29288394 DOI: 10.1007/s00701-017-3448-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND While the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid endoscopic transorbital approach, has been proposed to access the skull base. Accordingly, we aimed to evaluate the feasibility of this route to the petrous apex, providing a qualitative and quantitative analysis of this relatively novel pathway. METHODS Five human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. After proper dissection planning, anterior petrosectomy via the endoscopic transorbital route was performed. Specific quantitative analysis, as well as dedicated three-dimensional reconstruction, was done. RESULTS Using the endoscopic transorbital approach, it was possible to reach the petrous apex with an average volume bone removal of 1.33 ± 0.21 cm3. Three main intradural spaces were exposed: cerebellopontine angle, middle tentorial incisura, and ventral brainstem. The first one was bounded by the origin of the trigeminal nerve medially and the facial and vestibulocochlear nerves laterally, the second extended from the origin of the oculomotor nerve to the entrance of the trochlear nerve into the tentorium free edge while the ventral brainstem area was hardly accessible through the straight, ventral endoscopic transorbital trajectory. CONCLUSION This is the first qualitative and quantitative anatomic study concerning details of the lateral aspect of the incisura and ventrolateral posterior fossa reached via the transorbital window. This manuscript is intended as a feasibility anatomic study, and further clinical contributions are mandatory to confirm the effectiveness of this approach, defining its possible role in the neurosurgical armamentarium.
Collapse
Affiliation(s)
- Alberto Di Somma
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy.
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Comprehensive Stroke Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, OH, USA
| | - Luigi Maria Cavallo
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy
| | - Thomaz E Topczewski
- Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Federico Frio
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy
| | - Rosa Maria Gerardi
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy
| | - Jose Pineda
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Domenico Solari
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Cappabianca
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", 80131, Naples, Italy
| |
Collapse
|
18
|
Kloek CE, Jeng-Miller KW, Jacobs DS, Dunn IF. Prosthetic Replacement of the Ocular Surface Ecosystem Treatment of Ocular Surface Disease After Skull Base Tumor Resection. World Neurosurg 2018; 110:e124-e128. [DOI: 10.1016/j.wneu.2017.10.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
|
19
|
|