Petroclival Meningiomas: Factors Determining the Choice of Approach

Gustavo Rassier Isolan; Sâmia Yasin Wayhs; Guilherme Alves Lepski; Leandro Infantini Dini; Joel Lavinsky

doi:10.1055/s-0037-1608654

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2018; 79(04): 367-378
DOI: 10.1055/s-0037-1608654

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Petroclival Meningiomas: Factors Determining the Choice of Approach

Gustavo Rassier Isolan

¹Graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS); Neurotology and Acoustic Neuroma Center (CNNA); Clínica Lavinsky; Hospital Moinhos de Vento – Porto Alegre, Rio Grande do Sul, Brazil

²The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil

,

Sâmia Yasin Wayhs

³Graduate Program in Medicine: Surgical Sciences, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil

,

Guilherme Alves Lepski

⁴Department of Neurology, Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil

⁵Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany

,

Leandro Infantini Dini

²The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil

,

Joel Lavinsky

⁶Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil

⁷CNNA; Clínica Lavinsky, Porto Alegre, Rio Grande do Sul, Brazil

› Author Affiliations

Abstract

Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach.

Design Retrospective review.

Setting The study was conducted in a university hospital in southern Brazil.

Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve.

Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence.

Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6–75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery.

Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.

Keywords

brain tumor - clivus - meningioma - petroclival - skull base

Full Text

References

References
1 Yasargil MG, Mortara RW, Curcic M. Meningiomas of basal posterior cranial fossa. Adv Tech Stand Neurosurg 1980; 3-115 . doi: 10.1007/978-3-7091-7051-9_1
2 Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 1992; 31 (05) 813-828 , discussion 828
3 Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir (Wien) 1994; 129 (3-4): 113-120
4 Tatagiba M, Samii M, Matthies C, Vorkapic P. Management of petroclival meningiomas: a critical analysis of surgical treatment. Acta Neurochir Suppl (Wien) 1996; 65: 92-94
5 Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 1996; 84 (01) 20-28
6 Goel A. Extended lateral subtemporal approach for petroclival meningiomas: report of experience with 24 cases. Br J Neurosurg 1999; 13 (03) 270-275
7 Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 2005; 56 (03) 546-559 , discussion 546–559
8 Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007; 60 (06) 965-979 , discussion 979–981
9 Bambakidis NC, Kakarla UK, Kim LJ. , et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 2007; 61 (05) (Suppl. 02) 202-209 , discussion 209–211
10 Ramina R, Fernandes YB, Coelho Neto M. Petroclival meningiomas: diagnosis, treatment, and results. In: Ramina R, Tatagiba M. , eds. Samii's Essentials in Neurosurgery. Berlin: Springer Berlin Heidelberg; 2008: 121-135
11 Seifert V. Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years. Acta Neurochir (Wien) 2010; 152 (07) 1099-1116
12 Chen LF, Yu XG, Bu B, Xu BN, Zhou DB. The retrosigmoid approach to petroclival meningioma surgery. J Clin Neurosci 2011; 18 (12) 1656-1661
13 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (05) 1268-1277
14 Li D, Hao SY, Wang L. , et al. Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir (Wien) 2013; 155 (08) 1367-1383
15 Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O. True petroclival meningiomas: results of surgical management. J Neurosurg 2014; 120 (01) 40-51
16 Castellano F, Ruggiero G. Meningiomas of the posterior fossa. Acta Radiol Suppl 1953; 104: 1-177
17 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir (Wien) 1992; 118 (1-2): 27-32
18 Samii M, Tatagiba M, Carvalho GA. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome. J Neurosurg 2000; 92 (02) 235-241
19 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (01) 22-39
20 Hafez A, Nader R, Al-Mefty O. Preservation of the superior petrosal sinus during the petrosal approach. J Neurosurg 2011; 114 (05) 1294-1298
21 Wayhs SY, Lepski GA, Frighetto L, Isolan GR. Petroclival meningiomas: Remaining controversies in light of minimally invasive approaches. Clin Neurol Neurosurg 2017; 152: 68-75
22 Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M. Natural history of petroclival meningiomas. Neurosurgery 2003; 52 (01) 55-62 , discussion 62–64
23 Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 2000; 46 (03) 567-574 , discussion 574–575
24 Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PH. Surgical removal of small petroclival meningiomas. Acta Neurochir (Wien) 2008; 150 (05) 431-438 , discussion 438–439
25 Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005; 76 (10) 1425-1430
26 Nicolato A, Foroni R, Pellegrino M. , et al. Gamma knife radiosurgery in meningiomas of the posterior fossa. Experience with 62 treated lesions. Minim Invasive Neurosurg 2001; 44 (04) 211-217
27 Iwai Y, Yamanaka K, Nakajima H. Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas. Surg Neurol 2001; 56 (05) 308-314
28 Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC. Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 1998; 42 (03) 437-443 , discussion 443–445
29 Xu F, Karampelas I, Megerian CA, Selman WR, Bambakidis NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus 2013; 35 (06) E11
30 Flannery TJ, Kano H, Lunsford LD. , et al. Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg 2010; 112 (05) 957-964
31 Mayberg MR, Symon L. Meningiomas of the clivus and apical petrous bone. Report of 35 cases. J Neurosurg 1986; 65 (02) 160-167
32 Nishimura S, Hakuba A, Jang BJ, Inoue Y. Clivus and apicopetroclivus meningiomas--report of 24 cases. Neurol Med Chir (Tokyo) 1989; 29 (11) 1004-1011
33 Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 1992; 76 (04) 588-599
34 Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J. Petroclival meningiomas: is radical resection always the best option?. J Neurol Neurosurg Psychiatry 1997; 62 (04) 341-345
35 Abdel Aziz KM, Sanan A, van Loveren HR, Tew Jr JM, Keller JT, Pensak ML. Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery 2000; 47 (01) 139-150 , discussion 150–152
36 Park CK, Jung HW, Kim JE, Paek SH, Kim DG. The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol 2006; 66 (02) 160-165 , discussion 165–166
37 Mathiesen T, Gerlich A, Kihlström L, Svensson M, Bagger-Sjöbäck D. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 2007; 60 (06) 982-991 , discussion 991–992
38 Tahara A, de Santana Jr PA, Calfat Maldaun MV. , et al. Petroclival meningiomas: surgical management and common complications. J Clin Neurosci 2009; 16 (05) 655-659
39 Li PL, Mao Y, Zhu W, Zhao NQ, Zhao Y, Chen L. Surgical strategies for petroclival meningioma in 57 patients. Chin Med J (Engl) 2010; 123 (20) 2865-2873
40 Yang J, Fang T, Ma S. , et al. Large and giant petroclival meningiomas: therapeutic strategy and the choice of microsurgical approaches - report of the experience with 41 cases. Br J Neurosurg 2011; 25 (01) 78-85
41 Yamakami I, Higuchi Y, Horiguchi K, Saeki N. Treatment policy for petroclival meningioma based on tumor size: aiming radical removal in small tumors for obtaining cure without morbidity. Neurosurg Rev 2011; 34 (03) 327-334 , discussion 334–335
42 Watanabe T, Katayama Y, Fukushima T, Kawamata T. Lateral supracerebellar transtentorial approach for petroclival meningiomas: operative technique and outcome. J Neurosurg 2011; 115 (01) 49-54
43 Shi W, Shi JL, Xu QW, Che XM, Ju SQ, Chen J. Temporal base intradural transpetrosal approach to the petoclival region: an appraisal of anatomy, operative technique and clinical experience. Br J Neurosurg 2011; 25 (06) 714-722
44 Kusumi M, Fukushima T, Mehta AI. , et al. Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas. J Neurosurg 2012; 116 (03) 566-573
45 Matsui T. Therapeutic strategy and long-term outcome of meningiomas located in the posterior cranial fossa. Neurol Med Chir (Tokyo) 2012; 52 (10) 704-713
46 Morisako H, Goto T, Ohata K. Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation. J Neurosurg 2015; 122 (02) 373-380
47 da Silva CE, de Freitas PE. Large and giant skull base meningiomas: the role of radical surgical removal. Surg Neurol Int 2015; 6: 113
48 Zhou QJ, Liu B, Geng DJ. , et al. Microsurgery with or without neuroendoscopy in petroclival meningiomas. Turk Neurosurg 2015; 25 (02) 231-238