Petrosal Meningiomas: Factors Affecting Outcome and the Role of Intraoperative Multimodal Assistance to Microsurgery
| Autor: | Antonino Scibilia, Francesco Tomasello, Antonino Germanò, Domenico La Torre, Alfredo Conti, Salvatore Cardali, Filippo Flavio Angileri |
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| Přispěvatelé: | Tomasello, Francesco, Angileri, Filippo Flavio, Conti, Alfredo, Scibilia, Antonino, Cardali, Salvatore, La Torre, Domenico, Germanò, Antonino |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Microsurgery medicine.medical_specialty Indocyanine green videoangiography medicine.medical_treatment Skull Neoplasms Cerebellopontine Angle Meningioma 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Posterior fossa meningioma Intraoperative neurophysiological monitoring medicine Humans Progression-free survival Karnofsky Performance Status Aged Retrospective Studies medicine.diagnostic_test business.industry Endoscopic assistance Retrospective cohort study Middle Aged medicine.disease Neurovascular bundle Endoscopy Treatment Outcome chemistry 030220 oncology & carcinogenesis Petrous bone meningiomas Intraoperative neurophysiological monitoring Endoscopic assistance Indocyanine green videoangiography Posterior fossa meningioma Female Surgery Neurology (clinical) Radiology Petrous bone meningioma business Indocyanine green 030217 neurology & neurosurgery Petrous Bone |
| Popis: | Petrous meningiomas (PMs) represent a subset of posterior fossa tumors accounting for ∼8% of all intracranial meningiomas. Surgical treatment of PMs is challenging because of their relationships with vital neurovascular structures of the cerebellopontine angle. OBJECTIVE: To investigate independent pre- and intraoperative predictors of PM surgery outcome. METHODS: We reviewed the surgical and outcome data of patients who underwent microsurgical resection of PMs from 1997 to 2016. From 2007 onward, a multimodal intraoperative protocol consisting of intraoperative neuromonitoring (IONM), endoscopy, and indocyanine green (ICG) videoangiography was applied. Outcome variables included extent of resection, Karnofsky performance status (KPS), overall survival, and progression-free survival (PFS). RESULTS: A total of 54 patients were included. Independent predictors of gross total resection (GTR) included retromeatal location (P < .0175; odds ratio [OR] 4.05), absence of brainstem compression (P < .02; OR 3.55), and histological WHO grade I (P < .001; OR 3.47). Nongiant size (P < .012; OR 4.38), and WHO grade I (P < .0001; OR 7.7) were independent predictors of stable or improved KPS. The use of multimodal intraoperative tools to assist surgery independently predicted GTR (P < .002; OR 6.8) and good KPS (P < .018; OR 4.23). Nongiant size (P = .01) and WHO grade I (P = .002) were significantly associated with increased PFS. CONCLUSION: Notwithstanding the limitations of a retrospective study, our results suggest that support of microsurgery by a combination of IONM, endoscopy, and ICG videoangiography may improve patient outcome in PM surgery. |
| Databáze: | OpenAIRE |
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