Petroclival Meningioma: Management Strategy and Results in 21st Century

Achieving Gross Total Resection in Neurosurgery: A Review of Intraoperative Techniques and Their Influence on Surgical Goals

The definition of complete resection in neurosurgery depends on tumor type, surgical aims, and postoperative investigations, directly guiding the choice of intraoperative tools. Most common tumor types present challenges in achieving complete resection due to their infiltrative nature and anatomical constraints. The development of adjuvant treatments has altered the balance between oncological aims and surgical risks. We review local recurrence associated with incomplete resection based on different definitions and emphasize the importance of achieving maximal safe resection in all tumor types. Intraoperative techniques that aid surgeons in identifying tumor boundaries are used in practice and in preclinical or clinical research settings. They encompass both conservative and invasive techniques. Among them, morphological tools include imaging modalities such as intraoperative magnetic resonance imaging, ultrasound, and optical coherence tomography. Fluorescence-guided surgery, mainly using 5-aminolevulinic acid, enhances gross total resection in glioblastomas. Nuclear methods, including positron emission tomography probes, provide tumor detection based on beta or gamma emission after a radiotracer injection. Mass spectrometry- and spectroscopy-based methods offer molecular insights. The adoption of these techniques depends on their relevance, effectiveness, and feasibility. With the emergence of positron emission tomography imaging for use in recurrence benchmarking, positron emission tomography probes raise particular interest among those tools. While all such tools provide valuable insights, their clinical benefits need further evaluation.

[Anterior transpetrosal (Kawase) approach for petroclival meningioma with trigeminal neuralgia: case report and literature review]

The authors present a patient with petroclival meningioma complicated by trigeminal neuralgia. Resection of tumor via anterior transpetrosal approach with microvascular decompression of the trigeminal nerve was performed. A 48-year-old female patient presented with left-sided (V1-V2) trigeminal neuralgia. Magnetic resonance imaging revealed a tumor 33´27´25 mm with a base adjacent to the top of petrous part of the left temporal bone, tentorium cerebelli and clivus. Intraoperative examination revealed true petroclival meningioma extending to trigeminal notch of petrous part of temporal bone. There was additional compression of trigeminal nerve by caudal branch of superior cerebellar artery. Total resection of tumor was followed by disappearance of vascular compression of trigeminal nerve and regression of trigeminal neuralgia. Anterior transpetrosal approach provides early devascularization and resection of true petroclival meningioma, as well as wide imaging of anterolateral surface of the brainstem, identification of neurovascular conflict and vascular decompression.

Treatment Strategies and Current Results of Petroclival Meningiomas

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.

Surgical management of skull base meningiomas and vestibular schwannomas

PURPOSE OF REVIEW

The aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base.

RECENT FINDINGS

Meningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity. Also, the widespread use of neuroimaging and the progressive and constant aging of the populations inevitably result in the increase of detection rate of incidental (asymptomatic) neoplasm.Nowadays, there are still controversies about the correct management strategy.

SUMMARY

Surgery represents the gold standard treatment, with the objective of gross total resection; however, it is not always feasible due to localization, encasement of neuro-vascular structure, invasion of cranial nerve and brain parenchyma. Stereotactic radiosurgery and radiation therapy are important to achieve a satisfactory functional outcome and tumor control in case of residue or recurrence. A multidisciplinary approach is pivotal.

Histopathological Correlation (World Health Organization Classification) of Meningiomas and Their Anatomical Localization: A Multicenter Epidemiological Study in Mexico

OBJECTIVE

To determine the epidemiology of the localization and histological type of meningiomas in the Mexican population and the distribution of the different histological patterns and their relationship to tumor localization and patient demographics.

METHODS

A retrospective analysis was performed in 5 hospitals in Mexico from 2009 to 2019. For qualitative variables, mean values were compared using Pearson χ² test for the correlation between location and histological pattern as well as the clinical presentation and the patient's sex. Student t test was performed for age and its correlation with location and histology.

RESULTS

Analysis of 179 patients revealed significant differences in histopathological pattern, patient sex, and tumor location. No significant differences were found for age or clinical presentation in association with any specific histological pattern.

CONCLUSIONS

There was a correlation between the histology of the 15 histopathological varieties of meningiomas and the predilection site of appearance as well as certain demographic aspects, such as sex. This study lays the foundation for future studies in Mexico on the differentiation and typing of meningiomas regardless of the histological grade to which they belong, as the exact behavior of these tumors, including grade I tumors, remains unknown to date.