J Neurol Surg B Skull Base 2012; 73(01): 54-63
DOI: 10.1055/s-0032-1304557
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Subtemporal Transtentorial Petrosalapex Approach for Giant Petroclival Meningiomas: Analyzation and Evaluation of the Clinical Application[*]

Jun Yang
1   Department of Neurosurgery, Fuxing Hospital, Capital University of Medical Sciences, The Third Neurosurgical Department of Capital University of Medical Science, Beijing;
,
Yan-Hong Liu
2   Department of Editorial, Beijing Neurosurgery Institute, Beijing;
,
Shun-Chang Ma
1   Department of Neurosurgery, Fuxing Hospital, Capital University of Medical Sciences, The Third Neurosurgical Department of Capital University of Medical Science, Beijing;
,
Lin Wei
3   Department of Neurosurgery, Qianfoshan Hospital, Shandong University, Shandong Province;
,
Rui-Sheng Lin
4   Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian Province, China.
,
Jian-Fa Qi
1   Department of Neurosurgery, Fuxing Hospital, Capital University of Medical Sciences, The Third Neurosurgical Department of Capital University of Medical Science, Beijing;
,
Ye-Shuai Hu
1   Department of Neurosurgery, Fuxing Hospital, Capital University of Medical Sciences, The Third Neurosurgical Department of Capital University of Medical Science, Beijing;
,
Chun-Jiang Yu
1   Department of Neurosurgery, Fuxing Hospital, Capital University of Medical Sciences, The Third Neurosurgical Department of Capital University of Medical Science, Beijing;
› Institutsangaben
Weitere Informationen

Publikationsverlauf

28. April 2011

10. August 2011

Publikationsdatum:
24. Februar 2012 (online)

Abstract

With the advent of microsurgery and surgical techniques, along with the improvement in neuroimaging techniques and the microanatomy in cadaver study, improvement in terms of surgical morbidity and mortality has been remarkable; however, controversy still exists regarding the optimal surgical strategies for giant petroclival meningiomas (GPMs). We report a study of clinical and radiological features as well as the surgical findings and outcomes for patients with GPM treated at our institution over the past 6 years. During a 6-year period (April 2004 to March 2010), 16 patients with GPM underwent surgery by subtemporal transtentorial petrosal apex approach during which electrophysiological monitoring of cranial nerves and brainstem function were reviewed. There were nine females and seven males with a mean age of 56.9 years (range from 32 to 78 years). The most frequent clinical manifestations were headache (93.7%) and dizziness (93.7%). Regions and directions of tumor extension include clivus, parasellar, and cavernous sinus, as well as compression of brainstem, and so on. The trochlear nerve was totally wrapped in nine cases (56.2%). The postoperative Karnofsky Performance Scale (KPS) score was 76.3 ± 13.1. Mean maximum diameter of the tumors on magnetic resonance imaging was 5.23 cm (range, 4.5 to 6.2 cm). Subtemporal transtentorial petrosalapex approach was performed in all 16 cases. Gross total resection was achieved in 14 cases (87.5%) and subtotal resection in 2 cases (12.5%) with no resultant mortality. Follow-up data were available for all 16 patients, with a mean follow-up period of 28.8 months (range from 4 to 69 months), of which 11 (68.75%) lived a normal life (KPS, 80–100). Our suggestion is that GPM could be completely resected by subtemporal transtentorial petrosalapex approach. The surgical strategy of GPM should be focused on survival and postoperative quality of life. Microneurosurgical technique plays a key role in tumor resection and preservation of nerve function. Intraoperative electrophysiological monitoring also contributes dramatically to the preservation of the nerve function. Complete resection of the tumor should be attempted at the first operation. Any remnant is treated by radiosurgery.

* This article was originally Published online in Skull Base on December 1, 2011 (DOI:10.1055/s-0031-1296037)


 
  • References

  • 1 Gong J, Yu CJ, Guan SS , et al. Modified surgical approaches to the petroclival region: an anatomic study. Chin J Minim Invasive Neurosurg 2005; 10: 26-29
  • 2 Mathiesen T, Gerlich A, Kihlström L, Svensson M, Bagger-Sjöbäck D. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 2008; 62 (6) , Suppl (Suppl. 03) 1213-1223
  • 3 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir (Wien) 1992; 118 (1-2) 27-32
  • 4 Yang J, Yu CJ, Qi Z , et al. Microsurgical management of giant petroclival meningiomas. Chin J Neurosurg 2008; 24 (3) 190-192
  • 5 Yu CJ, Wang ZC, Guan SS, Sun HL. Microsurgical treatment of giant petroclival tumors (report of experiences with 15 cases). Chin J Neurosurg 1997; 13: 205-207
  • 6 Bambakidis NC, Kakarla UK, Kim LJ , et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 2007; 61 (5) , Suppl (Suppl. 02) 202-209, discussion 209–211
  • 7 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus 2005; 19 (2) E7
  • 8 Ying M, Liang ZF, Rong Z, Wei Z. Microinvasive approach for surgery on petroclival meningiomas. Chin J Microsurg 2005; 28: 99-102
  • 9 Sekhar LN, Jannetta PJ, Burkhart LE, Janosky JE. Meningiomas involving the clivus: a six-year experience with 41 patients. Neurosurgery 1990; 27 (5) 764-781, discussion 781
  • 10 Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 1996; 84 (1) 20-28
  • 11 Mayberg MR, Symon L. Meningiomas of the clivus and apical petrous bone. Report of 35 cases. J Neurosurg 1986; 65 (2) 160-167
  • 12 Iaconetta G, Fusco M, Samii M. The sphenopetroclival venous gulf: a microanatomical study. J Neurosurg 2003; 99 (2) 366-375
  • 13 Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura T. Clivus meningioma: six cases of total removal. Neurol Med Chir (Tokyo) 1977; 17 (1 Pt 1) 63-77
  • 14 Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 1988; 30 (2) 108-116
  • 15 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988; 22 (3) 510-517
  • 16 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 1991; 28 (6) 869-875, discussion 875–876
  • 17 Malis LI. Suboccipital subtemporal approach to petroclival tumors. In: Wilson CB, ed Neurosurgical Procedures: Personal Approached to Classic Operations. Baltimore: Williams & Wilkins; 1992: 41-51
  • 18 Cho CW, Al-Mefty O. Combined petrosal approach to petroclival meningiomas. Neurosurgery 2002; 51 (3) 708-716, discussion 716–718
  • 19 Goel A, Muzumdar D. Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. Surg Neurol 2004; 62 (4) 332-338, discussion 338–340
  • 20 Samii M, Tatagiba M, Carvalho GA. Resection of large petroclival meningiomas by the simple retrosigmoid route. J Clin Neurosci 1999; 6 (1) 27-30
  • 21 Zhu W, Mao Y, Zhou LF, Zhang R, Chen L. Combined subtemporal and retrosigmoid keyhole approach for extensive petroclival meningioma surgery: report of experience with 7 cases. Minim Invasive Neurosurg 2007; 50 (2) 106-110
  • 22 Shen T, Friedman RA, Brackmann DE , et al. The evolution of surgical approaches for posterior fossa meningiomas. Otol Neurotol 2004; 25 (3) 394-397
  • 23 Spallone A, Makhmudov UB, Mukhamedjanov DJ, Tcherekajev VA. Petroclival meningioma. An attempt to define the role of skull base approaches in their surgical management. Surg Neurol 1999; 51 (4) 412-419, discussion 419–420
  • 24 Tahara A, de Santana Jr PA, Calfat Maldaun MV , et al. Petroclival meningiomas: surgical management and common complications. J Clin Neurosci 2009; 16 (5) 655-659
  • 25 Koperna T, Tschabitscher M, Knosp E. The termination of the vein of “Labbé” and its microsurgical significance. Acta Neurochir (Wien) 1992; 118 (3-4) 172-175
  • 26 Tanriover N, Abe H, Rhoton Jr AL, Kawashima M, Sanus GZ, Akar Z. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches. J Neurosurg 2007; 106 (6) 1041-1050
  • 27 Koerbel A, Gharabaghi A, Safavi-Abbasi S , et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. Eur J Surg Oncol 2009; 35 (7) 773-779
  • 28 Roberti F, Sekhar LN, Kalavakonda C, Wright DC. Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 2001; 56 (1) 8-20, discussion 20–21
  • 29 Sekhar LN, Javed T. Meningiomas with vertebrobasilar artery encasement: review of 17 cases. Skull Base Surg 1993; 3 (2) 91-106
  • 30 Neu M, Strauss C, Romstöck J, Bischoff B, Fahlbusch R. The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery. Clin Neurophysiol 1999; 110 (11) 1935-1941
  • 31 Iwai Y, Yamanaka K, Morikawa T. Adjuvant gamma knife radiosurgery after meningioma resection. J Clin Neurosci 2004; 11 (7) 715-718
  • 32 Linskey ME, Davis SA, Ratanatharathorn V. Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. J Neurosurg 2005; 102 (Suppl): 59-70