Long term surgical results of 154 petroclival meningiomas: A retrospective multicenter study
| Autor: | F. Bernard, L. Troude, S. Isnard, J.-M. Lemée, L.M. Terrier, P. François, S. Velut, E. Gay, H.-D. Fournier, P.-H. Roche |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Skull Base Neoplasms Neurosurgical Procedures Radiosurgery Meningioma Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Recurrence medicine Humans Radical surgery Child Aged Retrospective Studies Neurologic Examination business.industry Medical record Cranial nerves Perioperative Middle Aged Microsurgery medicine.disease Progression-Free Survival Surgery Radiation therapy Treatment Outcome Cranial Fossa Posterior 030220 oncology & carcinogenesis Female Neurology (clinical) Nervous System Diseases business 030217 neurology & neurosurgery Follow-Up Studies Petrous Bone |
| Zdroj: | Neurochirurgie. 65:55-62 |
| ISSN: | 0028-3770 |
| DOI: | 10.1016/j.neuchi.2019.02.001 |
| Popis: | Background Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. Methods A multicenter study of patients with PCMs larger than 2.5 cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients’ medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. Results There were 154 patients. The follow-up was 76.8 months on average (range 8–380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. Conclusions Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect