Modified Transpetrosal-Transtentorial Approach for Resection of Large and Giant Petroclival Meningioma: Technical Nuance and Surgical Experiences.
| Autor: | Haq IBI; Department of Neurosurgery, dr. Soetomo Academic General Hospital, Surabaya, Indonesia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Wahyuhadi J; Department of Neurosurgery, dr. Soetomo Academic General Hospital, Surabaya, Indonesia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Suryonurafif A; Department of Neurosurgery, dr. Soetomo Academic General Hospital, Surabaya, Indonesia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Arifianto MR; Department of Neurosurgery, dr. Soetomo Academic General Hospital, Surabaya, Indonesia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Susilo RI; Department of Neurosurgery, dr. Soetomo Academic General Hospital, Surabaya, Indonesia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Nagm A; Department of Neurosurgery, Al-Azhar University/Faculty of Medicine Nasr City, Cairo, Egypt., Goto T; Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan., Ohata K; Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of neurological surgery. Part A, Central European neurosurgery [J Neurol Surg A Cent Eur Neurosurg] 2022 Nov; Vol. 83 (6), pp. 578-587. Date of Electronic Publication: 2021 Nov 18. |
| DOI: | 10.1055/s-0041-1731753 |
| Abstrakt: | Background: Meningiomas arising from the petroclival area remain a challenge for neurosurgeons. Various approaches have been proposed to achieve maximum resection with minimal morbidity and mortality. Also, some articles correlated preservation of adjacent veins with less neurologic deficits. Objective: To describe the experiences in using a new technique to achieve maximal resection of petroclival meningiomas and preserving the superior petrosal veins (SPVs) and the superior petrosal sinus (SPS). Methods: A retrospective analysis of 26 patients harboring a true petroclival meningioma with a diameter ≥25 mm and undergoing surgery with the modified transpetrosal-transtentorial approach (MTTA) was performed. Results: Fifty-four percent of 22 patients complained of severe headache at presentation. There was also complaint of cranial nerve (CN) deficit, with CN VII deficit being the most common (present in 42% of patients). The average tumor size (measured as maximum diameter) was 45.2 mm, and most of the tumors compressed the brainstem. Total resection was achieved in 12 patients (46.2%), whereas the others were excised subtotally (54.8%). Most of the patients had WHO grade I (96.1%) meningioma; only one had a grade II (3.8%) meningioma. In addition, clinical improvement and persistence of symptoms were observed in 17 (65.4%) and 8 (30.7%) patients, respectively, and postoperative permanent CN injury was observed in 3 (11.5%) patients. Conclusion: Using the MTTA, maximal resection with preservation of the CNs and neurovascular SPV-SPS complex can be achieved. Therefore, further studies and improvements of the technique are required to increase the total resection rate without neglecting the complications that may develop postoperatively. Competing Interests: None declared. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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