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Arima H, Watanabe Y, Tanoue Y, Morisako H, Kawakami T, Ichinose T, Goto T. Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma. J Clin Med 2023; 12:7717. [PMID: 38137785 PMCID: PMC10744082 DOI: 10.3390/jcm12247717] [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: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
To identify the characteristics of feeding arteries in skull base meningioma including location and prevalence, we evaluated the distributions and types of feeding arteries in skull base meningioma by cerebral angiography and assessed relationships to tumor attachment. We enrolled patients with skull base meningioma who underwent MRI and cerebral digital subtraction angiography (DSA), from September 2015 to October 2022. Subjects comprised 115 patients (32 males, 83 females; mean age, 52.7) with 117 meningiomas, showing tumor attachments around the "cavernous sinus to the upper part of the clivus" (Area 1), "lower part of the clivus to foramen magnum" (Area 2), and "tentorium around the petrous bone" (Area 3). Frequent arteries, such as the dorsal meningeal artery (DMA), the ascending pharyngeal artery (APA), the tentorial artery (TA), and the petrosal branch (PB) of the middle meningeal artery (MMA) were analyzed in terms of their associations with tumor attachment to Areas 1-3. Meningiomas with the DMA as a feeding artery correlated with tumor attachment to Area 1 (p < 0.001). Meningiomas with the APA correlated with tumor attachment to Area 2 (p < 0.001). Meningiomas with the TA correlated with tumor attachment to Area 3 (p < 0.001). The PB correlated with Area 3 (p < 0.05). Our study founded that visualization of these arteries correlated well with specific areas. These arteries were also the main feeders in each type of skull base meningioma.
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Affiliation(s)
- Hironori Arima
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Yusuke Watanabe
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Taichiro Kawakami
- Department of Neurosurgery, Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Tsutomu Ichinose
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
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Adachi K, Hasegawa M, Hirose Y. Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study. Neurosurg Rev 2023; 46:137. [PMID: 37286772 DOI: 10.1007/s10143-023-02045-w] [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: 02/25/2023] [Revised: 04/06/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
The efficacy of spinal drain (SD) placement for cerebrospinal fluid (CSF) leakage prevention after the anterior transpetrosal approach (ATPA) remains unclear. Thus, we aimed to assess whether postoperative SD placement improved postoperative CSF leakage after a skull base reconstruction procedure using a small abdominal fat and pericranial flap and clarify whether bed rest with postoperative SD placement increased the length of hospital stay. This retrospective cohort study included 48 patients who underwent primary surgery using ATPA between August 2011 and February 2022. All cases underwent SD placement preoperatively. First, we evaluated the necessity of SD placement for CSF leakage prevention by comparing the postoperative routine continuous SD placement period to a period in which the SD was removed immediately after surgery. Second, the effects of different SD placement durations were evaluated to understand the adverse effects of SD placement requiring bed rest. No patient with or without postoperative continuous SD placement developed CSF leakage. The median postoperative time to first ambulation was 3 days shorter (P < 0.05), and the length of hospital stay was 7 days shorter (P < 0.05) for patients who underwent SD removal immediately after surgery (2 and 12 days, respectively) than for those who underwent SD removal on postoperative day 1 (5 and 19 days, respectively). This skull base reconstruction technique was effective in preventing CSF leakage in patients undergoing ATPA, and postoperative SD placement was not necessary. Removing the SD immediately after surgery can lead to earlier postoperative ambulation and shorter hospital stay by reducing medical complications and improving functional capacity.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan.
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan
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Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives. Cancers (Basel) 2022; 14:cancers14122878. [PMID: 35740543 PMCID: PMC9220797 DOI: 10.3390/cancers14122878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. Over time, several corridors have been proposed, each one carrying its own pros and cons. During the last decades, the endoscopic endonasal route has been asserted among the classic routes for a growing number of midline and paramedian lesions. Therefore, the aim of our paper is to present a comprehensive review of the indications and techniques for the management of skull base meningiomas, emphasizing the ambivalent and complementary role of the low and high routes. Abstract Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.
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McCormack IG, Xu L, Nerva J, Berry JF, Melgar M, Wysiadecki G, Walocha J, Iwanaga J, Dumont AS, Tubbs RS. Anatomy of the Dorsal Meningeal Artery Including Its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging. World Neurosurg 2021; 155:e41-e48. [PMID: 34365050 DOI: 10.1016/j.wneu.2021.07.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The blood supply to the skull base is important to surgeons and those performing interventional and diagnostic procedures in this region. However, 1 vessel with a vast distribution in this area, the dorsal meningeal artery (DMA), has had few anatomic studies performed to investigate not only its normal anatomy but also its variations. Therefore the current study aimed to analyze the DMA via cadaveric dissection. METHODS In 10 adults, latex-injected, cadaveric heads (20 sides), the DMA was dissected using a surgical microscope. This artery and its branches were documented and measured. RESULTS A DMA was identified on all sides. In the majority (85%), it was a branch of the meningohypophysial trunk or common stem with either the inferior hypophysial or tentorial arteries and always had branches that traversed the basilar venous plexus. Multiple branches of the DMA were identified and categorized as bony, dural, neural, and vascular. CONCLUSIONS Surgeons operating at the skull base or clinicians interpreting imaging of this area should have a good working knowledge of the DMA and its typical and variant anatomy.
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Affiliation(s)
- Isabella G McCormack
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lu Xu
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John Nerva
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John F Berry
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Miguel Melgar
- Memorial Neurosciences Center, Memorial Hospital at Gulfport, Gulfport, Mississippi, USA
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Queensland University, Brisbane, Australia
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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: 24] [Impact Index Per Article: 8.0] [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.
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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
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Yoshida K, Akiyama T, Takahashi S, Miwa T, Horiguchi T, Sasaki H, Toda M. Cone-Beam Computed Tomography Fusion Technique for Vascular Assessment of Skull Base Meningiomas. World Neurosurg 2021; 151:61-69. [PMID: 33901735 DOI: 10.1016/j.wneu.2021.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cone-beam computed tomography (CBCT) images for skull base tumors provide detailed vascular information and localization in regard to surrounding bony structures. We report use of the CBCT fusion technique for skull base meningiomas. METHODS Six patients with petroclival or petrotentorial meningiomas supplied by multiple arterial systems were preoperatively evaluated using CBCT fusion imaging. Fusion images were reconstructed from three-dimensional rotational angiography with contrast agent injections from the internal carotid artery (ICA) and external carotid artery in 4 cases, vertebral artery and external carotid artery in 1 case, and ICA and vertebral artery in 1 case. RESULTS The feeding pedicles and tumor stains from 2 arterial systems were differentiated by separate colors. The courses and territories of the ICA dural feeders or ICA/vertebral artery pial feeders were easily distinguished from the external carotid artery dural feeders. Anastomoses between thin feeders from different arterial systems could be detected. Mixed stain (stain with both colors) was observed in some tumor compartments, suggesting dual supply from 2 arterial systems and the presence of peritumoral anastomoses. All patients underwent preoperative embolization without complications. CONCLUSIONS CBCT fusion images clearly visualized the feeders from each arterial system, the vascular compartments within the tumor, and possible peritumoral anastomoses. This technique provides a substantial contribution to both preoperative embolization and surgical resection of skull base meningiomas.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Takahashi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Horiguchi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Adachi K, Murayama K, Hayakawa M, Hasegawa M, Muto J, Nishiyama Y, Ohba S, Hirose Y. Objective and quantitative evaluation of angiographic vascularity in meningioma: parameters of dynamic susceptibility contrast-perfusion-weighted imaging as clinical indicators of preoperative embolization. Neurosurg Rev 2020; 44:2629-2638. [DOI: 10.1007/s10143-020-01431-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
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Adachi K, Hasegawa M, Hirose Y. Prediction of trigeminal nerve position based on the main feeding artery in petroclival meningioma. Neurosurg Rev 2020; 44:1173-1181. [PMID: 32424648 DOI: 10.1007/s10143-020-01313-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/09/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
The trigeminal nerve is often displaced by petroclival meningioma (PCM) compression, making it difficult to locate during PCM surgery. This study investigated whether the deviated position of the trigeminal nerve could be easily predicted using the main tumor feeding artery. We retrospectively examined 32 patients who underwent surgery for primary PCM. The deviation of the trigeminal nerve was classified as either Type 1 (displacement toward the back of the cerebellar tentorium), Type 2 (toward the back of the superior petrosal sinus), Type 3 (toward the back of the petrous apex dura), Type 4 (toward the inferior aspect of the tumor), or Type 5 (toward the surface of the brain stem). The main feeding artery was determined by preoperative angiography. The trigeminal nerve was classified as Type 2 in 60% of cases where the proximal tentorial artery (TA) was the main feeding vessel. The nerve was Type 5 where the distal portion of the TA was the main feeding vessel (60% of the cases). The nerves were Type 3 and Type 4 where the proximal inferior lateral trunk (ILT) (60%) and distal ILT (75%), respectively, were the main feeding vessels. In 66.7% of the cases where the dorsal meningeal artery was the main feeding vessel, the nerve was Type 3. Type 1 classification applied in all cases where the ascending pharyngeal artery was the main feeding artery. The main feeding artery can be used to predict trigeminal nerve transposition during PCM surgery.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
| | - Mituhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan
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Kondo K, Nemoto M, Harada N, Masuda H, Ando S, Kubota S, Sugo N. Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach. World Neurosurg 2019; 127:e609-e616. [DOI: 10.1016/j.wneu.2019.03.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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Adachi K, Hasegawa M, Hayakawa M, Tateyama S, Hirose Y. Susceptibility-Weighted Imaging of Deep Venous Congestion in Petroclival Meningioma. World Neurosurg 2018; 122:e20-e31. [PMID: 30236813 DOI: 10.1016/j.wneu.2018.08.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Protecting the venous drainage route during surgery in cases of petroclival meningioma (PCM) is important. Identifying venous congestion preoperatively can be valuable in reducing the risks associated with venous congestion during surgery. In this study, we examined the utility of susceptibility-weighted imaging (SWI) in identifying the presence of venous congestion in PCM cases preoperatively and identified the factors associated with it. METHODS We retrospectively examined 24 patients who had undergone surgery for primary PCM. The areas of the basal and internal cerebral veins on the affected and unaffected sides, obtained using SWI, were compared to identify venous congestion. We further examined the association between multiple candidate factors that are thought to be related to venous congestion and venous congestion using statistical analyses. RESULTS SWI could successfully identify venous congestion in 11 of 24 PCM cases. Among the 12 factors examined, those associated with venous congestion were an extension of the tumor, over the midline or upward, which is known to disturb the venous flow at the brainstem surface; anastomosis of the superficial cerebral vein (i.e., bypass route for venous congestion); and a high ABC Surgical Risk Scale score, an indicator of postoperative neurologic deterioration. CONCLUSIONS We showed that SWI is useful for evaluating venous congestion in PCM cases preoperatively and for identifying factors reflecting the risk of venous congestion. Taken together, our findings provide a multimodal strategy for the preoperative prediction of venous congestion, which could facilitate the treatment of PCM.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan.
| | - Mituhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan
| | - Motoharu Hayakawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan
| | - Shinichiro Tateyama
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan
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