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Matish M, Rathi A, Moon M. Atypical Intratemporal Meningioma Masquerading as Otitis Media-Clinical and Radiological Diagnostic Dilemma. Indian J Radiol Imaging 2021; 31:476-479. [PMID: 34556934 PMCID: PMC8448234 DOI: 10.1055/s-0041-1734410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Meningiomas are the most common intracranial extra-axial neoplasms with mostly straightforward radiological diagnosis; however, they can have unusual clinical and imaging manifestations posing diagnostic dilemma for radiologists and clinicians. The objective of this case report is to highlight the infrequent and misleading presentations of meningiomas to make an accurate diagnosis. A 65-year-old male patient presented with complaints of left recurrent otitis media and facial nerve palsy for past 6 months. On imaging, an aggressive predominantly cystic intracranial neoplasm was found in the left temporal fossa extending into the middle and external ear. Histopathological examination of the excised tumor revealed WHO grade I meningothelial meningioma. Meningiomas can show atypical imaging features such as large meningeal cysts, heterogenous or ring enhancement and aggressive features such as bone erosion. They can invade the middle ear and should be thought of while dealing with nonresponsive cases of otitis media.
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Affiliation(s)
- Mrinal Matish
- Department of Radiologist, Galaxy Vidarbha Diagnostic Centre, Nagpur, Maharashtra, India
| | - Abhishek Rathi
- Department of Radiologist, Galaxy Vidarbha Diagnostic Centre, Nagpur, Maharashtra, India
| | - Manasi Moon
- Department of Radiologist, Galaxy Vidarbha Diagnostic Centre, Nagpur, Maharashtra, India
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Abstract
The anatomy of the petrous face of the temporal bone, also known as the petrous pyramid, should be carefully examined to understand the location of, blood supply to, and venous drainage of meningiomas in this area (42%-59% of posterior fossa meningiomas). The petrous face is located in the skull base between the sphenoid and occipital bones. It consists of a base that joins the mastoid laterally and an apex that extends anteromedially to form the foramen lacerum. The anatomy can be divided into three surfaces: anterior/superior, posterior, and inferior. The anterior/superior surface is a continuation of the posteromedial portion of the middle cranial fossa with boundaries extending from the arcuate eminence to the petrous apex. The posterior surface is a continuation of the front part of the posterior cranial fossa with the internal auditory meatus at its center. The inferior surface contains foramina that transmit important vessels and cranial nerves. The vascular anatomy of the petrous face is also described, including branches of the carotid artery and vertebrobasilar systems. It is imperative to understand potential anastomotic routes between extracranial and intracranial arteries, as well as arterial supply to cranial nerves, to facilitate preoperative transarterial embolization of meningiomas and avoid neurologic complications during surgery.
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Affiliation(s)
- Ricky Chae
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Roberto Rodriguez Rubio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States.
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Zeleník K, Hanzlíková P, Blatová B, Formánek M, Komínek P. Temporal bone meningiomas: emphasizing radiologic signs to improve preoperative diagnosis. Eur Arch Otorhinolaryngol 2020; 278:271-273. [PMID: 32533237 DOI: 10.1007/s00405-020-06110-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Temporal bone meningioma is an extremely rare disease. Lack of clinical attention due to its rarity might lead to delayed diagnosis. This short communication aims to emphasize radiologic signs of temporal bone meningiomas to improve preoperative diagnosis. METHODS Radiological characteristics of temporal bone meningiomas are discussed. RESULTS Temporal bone meningioma is characterized by diffuse "hairy" trabecular hyperostosis without the destruction of trabecular structures, bone thickening, and irregular surface margins of the temporal bone on computed tomography. The dural tail sign is a unique feature of temporal bone meningioma on magnetic resonance imaging. CONCLUSION Otolaryngologists certainly should be aware of characteristic radiologic signs of temporal bone meningiomas. Using modern computed tomography and magnetic resonance imaging protocols enables with a high degree of accuracy to distinguish temporal bone meningiomas from other more common entities in this location.
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Affiliation(s)
- Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic. .,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic.
| | - Pavla Hanzlíková
- Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Barbora Blatová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
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Han JJ, Lee DY, Kong SK, Chang KH, Yoon YJ, Kim HJ, Lee HJ, Park MH, Koo JW, Kim YH. Clinicoradiologic Characteristics of Temporal Bone Meningioma: Multicenter Retrospective Analysis. Laryngoscope 2020; 131:173-178. [PMID: 32011010 DOI: 10.1002/lary.28534] [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: 07/18/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Meningioma is a neoplasm arising from cells related to the arachnoid villi. The aim of the present study was to explore the clinical and radiological characteristics of temporal bone meningioma (TBM) in a multicenter cohort. STUDY DESIGN Retrospective cohort study. METHODS Thirteen patients diagnosed with TBM at eight medical institutes between 1998 and 2018 were retrospectively enrolled. The clinical procedures, symptoms, signs, and images that led to the diagnosis of TBM were investigated for all patients. RESULTS The most common symptom at the initial visit was hearing loss (n = 12/13, 92.3%). All patients exhibited unilateral TBMs with varied symptom durations (1-60 months). Four patients presented masses occupying the external auditory canal; the tympanic membrane (TM) could not be evaluated. The other nine patients did not show TM perforation despite the presence of inflammatory signs. The majority of patients exhibited unilateral conductive or mixed hearing loss. A retrospective review of temporal bone computed tomography (TBCT) images revealed findings suggestive of a tumor in all patients. However, three patients had been misdiagnosed with chronic otitis media and were subjected to tympanomastoidectomy (n = 3/7, 42.9%). TBCT findings that suggested TBM included diffuse trabecular hyperostosis in the middle and posterior cranial fossae and widening and destruction of the temporal bone in the jugular bulb area. CONCLUSIONS TBM should be suspected if patients exhibit persistent inflammatory symptoms or signs involving intact TM or unilateral conductive or mixed hearing loss with trabecular hyperostosis or destruction of the temporal bone on computed tomography images. LEVEL OF EVIDENCE 4 Laryngoscope, 131:173-178, 2021.
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Affiliation(s)
- Jae Joon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, South Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Pusan, South Korea
| | - Ki-Hong Chang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong Joo Yoon
- Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University College of Medicine, Chonbuk, South Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Min-Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Elder TA, Yokoi H, Chugh AJ, Lagman C, Wu O, Wright CH, Ray A, Bambakidis N. En Plaque Meningiomas: A Narrative Review. J Neurol Surg B Skull Base 2019; 82:e33-e44. [PMID: 34306915 DOI: 10.1055/s-0039-3402012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
Abstract
Background En plaque meningiomas are a rare subtype of meningiomas that are frequently encountered in the spheno-orbital region. Characterized by a hyperostotic and dural invasive architecture, these tumors present unique diagnostic and treatment considerations. Objective The authors conduct a narrative literature review of clinical reports of en plaque meningiomas to summarize the epidemiology, clinical presentation, diagnostic criteria, and treatment considerations in treating en plaque meningiomas. Additionally, the authors present a case from their own experience to illustrate its complexity and unique features. Methods A literature search was conducted using the MEDLINE database using the following terminology in various combinations: meningioma , meningeal neoplasms, en plaque , skull base , spheno-orbital, and sphenoid wing . Only literature published in English between 1938 and 2018 was reviewed. All case series were specifically reviewed for sufficient data on treatment outcomes, and all literature was analyzed for reports of misdiagnosed cases. Conclusion En plaque meningiomas may present with a variety of symptoms according to their location and degree of bone invasion, requiring a careful diagnostic and treatment approach. While early and aggressive surgical resection is generally accepted as the optimal goal of treatment, these lesions require an individualized approach, with further investigation needed regarding the role of new therapies.
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Affiliation(s)
- Theresa A Elder
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Hana Yokoi
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - A Jessey Chugh
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Carlito Lagman
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Osmond Wu
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Christina Huang Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Abhishek Ray
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Nicholas Bambakidis
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
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Ito S, Saegusa T, Ozawa Y, Higuchi Y, Iwadate Y, Serizawa T, Nagano O, Kageyama Y, Yamakami I. Function-Preserving Multimodal Treatment for Jugular Foramen Meningiomas. J Neurol Surg B Skull Base 2019; 80:239-243. [PMID: 31143565 DOI: 10.1055/s-0038-1668137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022] Open
Abstract
Objectives Despite being pathologically benign, jugular foramen meningioma (JFM) may be locally aggressive and spread in three compartments. Because of the complex anatomical location, radical removal of JFM usually causes serious morbidity through lower cranial nerve (LCN) deficits. To accomplish long-standing tumor control with good functional outcomes, we report function-preserving multimodal treatment (FMT) for JFM, comprising the combination of intradural tumor removal with the preservation of LCN function and stereotactic radiosurgery (RS) for the residual tumor. Materials This study investigated six JFM patients (five women, one man). Preoperatively, five patients showed no LCN sign. Results All patients underwent function-preserving retrosigmoid intradural tumor removal, and no patient developed new LCN deficit. Three patients underwent RS for the residual tumor at 8 to 12 months after surgery. After RS, all three tumors were controlled. No patients showed tumor recurrence or new LCN deficits in the follow-up period (2 months to 8 years). Conclusion FMT for JFMs can accomplish long-standing tumor control with excellent functional outcomes.
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Affiliation(s)
- Seiro Ito
- Department of Neurosurgery, Chiba Rosai Hospital, Ichihara City, Chiba, Japan
| | - Takashi Saegusa
- Department of Neurosurgery, Chiba Rosai Hospital, Ichihara City, Chiba, Japan
| | - Yoshinori Ozawa
- Department of Neurosurgery, Chiba Rosai Hospital, Ichihara City, Chiba, Japan
| | - Yoshinori Higuchi
- Department of Neurosurgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurosurgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan
| | - Toru Serizawa
- Department of Neurosurgery, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Osamu Nagano
- Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Yusuke Kageyama
- Department of Neurosurgery, Seikei-kai Chiba Medical Center, Chiba, Japan
| | - Iwao Yamakami
- Department of Neurosurgery, Seikei-kai Chiba Medical Center, Chiba, Japan
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Non-paraganglioma tumors of the jugular foramen – Growth patterns, radiological presentation, differential diagnosis. Neurol Neurochir Pol 2015; 49:156-63. [DOI: 10.1016/j.pjnns.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
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Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A. Surgical treatment of jugular foramen meningiomas. Neurol Neurochir Pol 2014; 48:391-6. [PMID: 25482249 DOI: 10.1016/j.pjnns.2014.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/04/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECT We present our experience with surgery of jugular foramen meningiomas with special consideration of clinical presentation, surgical technique, complications, and outcomes. METHODS This retrospective study includes three patients with jugular foramen meningiomas treated by the senior author between January 2005 and December 2010. The initial symptom for which they sought medical help was decreased hearing. In all of the patients there had been no other neurological symptoms before surgery. The transcondylar approach with sigmoid sinus ligation at jugular bulb was suitable in each case. RESULTS No death occurred in this series. All of the patients deteriorated after surgery mainly due to the new lower cranial nerves palsy occurred. The lower cranial nerve dysfunction had improved considerably at the last follow-up examination but no patient fully recovered. Two of three patients with preoperatively impaired yet functional hearing deteriorated after surgery with no subsequent cranial nerve VIII function improvement. In one case postoperative stereotactic radiosurgery was performed due to non-radical tumour resection (Simpson Grade IV) and tumour remnant proved stable in the 4-year follow-up. None of the patients have shown signs of tumour recurrence in the mean follow-up period of 56 months. CONCLUSIONS Jugular foramen meningiomas represent one of the rarest subgroups of meningiomas and their surgical treatment is associated with significant risk of permanent cranial nerve deficits.
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Affiliation(s)
- Arkadiusz Nowak
- Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland.
| | - Tomasz Dziedzic
- Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Tomasz Czernicki
- Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Przemysław Kunert
- Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Andrzej Marchel
- Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland
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Falcioni M, Piccirillo E, Taibah A, Sanna M. Meningiomas intrinsic to the geniculate ganglion. Skull Base 2011; 11:297-302. [PMID: 17167632 PMCID: PMC1656877 DOI: 10.1055/s-2001-18636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Geniculate ganglion meningiomas are extremely rare lesions-only 14 cases have been reported in the literature. Two new cases of these tumors are described. On computed tomography and magnetic resonance imaging, both lesions appeared centered on the area of the geniculate ganglion, extending to the tympanic cleft and eroding the middle cranial fossa floor. The first case was treated through a middle cranial fossa approach. Because the tumor was so large in the second case, a subtotal petrosectomy was used. The authors review the literature to clarify the clinical and radiological characteristics of these tumors and their surgical treatment.
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BAKAR B. Jugular Foramen Meningiomas: Review of the Major Surgical Series. Neurol Med Chir (Tokyo) 2010; 50:89-96; disucussion 96-7. [DOI: 10.2176/nmc.50.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bulent BAKAR
- Department of Neurosurgery, Kirikkale University Faculty of Medicine
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Sanna M, Bacciu A, Falcioni M, Taibah A, Piazza P. Surgical Management of Jugular Foramen Meningiomas: A Series of 13 Cases and Review of the Literature. Laryngoscope 2007; 117:1710-9. [PMID: 17690614 DOI: 10.1097/mlg.0b013e3180cc20a3] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Primary meningiomas occurring within the jugular foramen are exceedingly rare lesions presumed to originate from arachnoid-lining cells situated within the jugular foramen. The objective of this study is to analyze the management and outcome in a series of 13 primary jugular foramen meningiomas collected at a single center. STUDY DESIGN Retrospective study. SETTING Quaternary referral otology and skull base private center. METHODS Charts belonging to 13 consecutive patients with pathologically confirmed jugular foramen meningioma surgically treated between September 1991 and May 2005 were examined retrospectively. The follow-up of the series ranged from 12 to 120 (mean, 42.8 +/- 27.5) months. RESULTS Four (28.5%) patients underwent single-stage tumor removal through the petro-occipital transigmoid (POTS) approach. In two patients with preoperative unserviceable hearing, a combined POTS-translabyrinthine approach was adopted. Two patients underwent a combined POTS-transotic approach because of massive erosion of the carotid canal. A modified transcochlear approach type D with posterior rerouting of the facial nerve and transection of the sigmoid sinus and jugular bulb was performed in two patients with a huge cerebellopontine angle tumor component with extension to the prepontine cistern together with massive involvement of the petrous bone and middle ear and encasement of the vertical and horizontal segments of the intrapetrous carotid artery. In one patient with evidence of a dominant sinus on the site of the tumor, a subtotal tumor removal via an enlarged translabyrinthine approach (ETLA) was planned to resect the intradural component of the tumor. Two patients in our series underwent a planned staged procedure on account of a huge tumor component in the neck. One of these patients underwent a first-stage infratemporal fossa approach type A to remove the tumor component in the neck; the second-stage intradural removal of the tumor was accomplished via an ETLA. The last patient underwent a first-stage modified transcochlear type D approach to remove the intradural tumor component followed by a second-stage transcervical procedure for removal of the extracranial component. Gross total tumor removal (Simpson grade I-II) was achieved in 11 (84.6%) cases. Subtotal removal of the tumor was accomplished in two patients. Good facial nerve function (grades I and II) was achieved in 46.1% of cases, whereas acceptable function (grade III) was achieved in the remaining cases 1 year after tumor removal. Hearing was preserved at the preoperative level in all four patients who underwent surgery via the POTS approach. After surgery, no patient recovered function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 61.5% of cases. CONCLUSIONS Surgical resection is the treatment of choice for jugular foramen meningiomas. Among the various surgical techniques proposed for dealing with these lesions, we prefer the POTS approach alone or combined with the translabyrinthine or transotic approaches. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge.
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Abstract
OBJECT Primary jugular fossa meningomas (JFMs) are one of the rarest subgroups of meningioma, with fewer than 40 cases reported in the literature. The authors retrospectively analyzed the results of surgical treatment in their series of patients, including clinical, pathological, and complication features. The surgical approach was mandated by the pathological anatomy of the tumor as well as by the anatomy of the individual patient. METHODS During a 6.5-year period, the authors performed nine surgeries in eight patients (seven women [88%] and one man [12%]) with JFMs. Six lesions occurred on the right side and two on the left. The most common presenting symptoms were altered hearing in five patients (62%), swallowing difficulties in four patients (50%), and a deficit of the 11th cranial nerve in three patients (38%); a combination of two or more signs or symptoms was common. The surgical approach was tailored to the local anatomy (tumor-neurovascular relationships) found in each patient; three different routes were used. Radical tumor removal was achieved in all patients; one tumor recurrence occurred after 20 months in a patient in whom the tumor had displayed atypical histological features. This woman underwent a second operation. The mean length of hospital stay was 1 week. The mean and the median follow-up period were 45 and 40 months, respectively. The most common complications were transient lower cranial nerve deficits, which resolved or were compensated for in all patients within 1 month. CONCLUSIONS With a careful, extensive preoperative evaluation and appropriate tailoring of the operative approach, JFMs can be radically resected with the expectation of good outcome.
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Affiliation(s)
- Kenan I Arnautović
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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