Outcomes of Endonasal and Lateral Approaches to Petroclival Meningiomas
| Autor: | Francisco Vaz Guimaraes Filho, Eric W. Wang, Maria Koutourousiou, Juan C. Fernandez-Miranda, Paul A. Gardner, Carl H. Snyderman, John R. de Almeida |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Skull Base Neoplasms Neurosurgical Procedures Young Adult 03 medical and health sciences 0302 clinical medicine medicine.artery Meningeal Neoplasms medicine Humans Karnofsky Performance Status Petroclival Meningioma Abducens nerve Aged Retrospective Studies medicine.diagnostic_test Cerebrospinal fluid leak business.industry Magnetic resonance imaging Cytoreduction Surgical Procedures Perioperative Middle Aged medicine.disease Debulking Surgery Hydrocephalus Treatment Outcome Cranial Fossa Posterior 030220 oncology & carcinogenesis Neuroendoscopy Female Neurology (clinical) Internal carotid artery Meningioma business 030217 neurology & neurosurgery Petrous Bone |
| Zdroj: | World Neurosurgery. 99:500-517 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2016.12.001 |
| Popis: | Transpetrosal approaches for the treatment of petroclival meningiomas are often associated with substantial morbidity and long recovery. With the goal of early clinical improvement, we have used less invasive surgical approaches for petroclival meningiomas.We retrospectively reviewed 32 patients with petroclival meningiomas. Eleven patients (34.4%) were managed with lateral approaches (retrosigmoid or far lateral approach), 17 (53.1%) with anterior midline approaches (endoscopic endonasal approach [EEA]), and 4 (12.5%) with a combination.The average Karnofsky Performance Score (KPS) at presentation was 73.8. The average postoperative KPS improved to 87.9 (P0.001) during short-term follow-up of 14 months (range, 1-42) and was significantly higher in primary tumors (P = 0.013), tumors4 cm (P = 0.039), and tumors without vascular encasement (P = 0.002) but remained significant regardless of age, tumor size, or vascular encasement. The greatest benefit occurred with primary tumors, in young patients and in those who underwent nontotal resection (P0.001). EEA had a significantly greater potential for improved KPS (P = 0.002). Gross (n = 6) or near total (n = 9) resection was achieved in 15 of 32 cases (47%). Complications included new cranial nerve palsies affecting mainly the abducens nerve (18.7%). New lower cranial nerve palsies occurred in only 1 case (3.1%). Other complications included postoperative hydrocephalus (15.6%) and cerebrospinal fluid leak (28.1%). One patient died in the perioperative period (3.1%).In the short-term, less aggressive cranial base approaches, including retrosigmoid exposures and the recently introduced EEA, are effective alternatives to transpetrosal approaches for debulking petroclival meningiomas with significant early clinical improvement and limited major surgical complications. |
| Databáze: | OpenAIRE |
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