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J Neurol Surg B Skull Base 2021; 82(06): 615-623
DOI: 10.1055/s-0040-1714112
Original Article

Impact of the Extent of Microsurgical Resection in Sphenopetro-clival Meningiomas Trough a Multistaged Approach: A Volumetric Analysis

Rafael Martínez-Pérez 
1   Department of Neurosurgery, Ohio State University, Columbus, Ohio, United States
2   Division of Skull Base and Vascular Neurosurgery, Institute of Neurosurgery Dr. Asenjo, Universidad de Chile, Santiago, Chile
,
Asterios Tsimpas
3   Department of Surgery, Section of Neurosurgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States
,
Mario Ganau
4   Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
,
Jorge M. Mura
2   Division of Skull Base and Vascular Neurosurgery, Institute of Neurosurgery Dr. Asenjo, Universidad de Chile, Santiago, Chile
5   Department of Neurosurgery, Clínica las Condes, Santiago, Chile
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Abstract

Objective Sphenopetroclival meningiomas (SPCMs) represent a challenge for surgical treatment. The authors used an objective volumetric analysis to assess the effect of the grade of resection and different surgical strategies that may affect the outcome of this tumors.

Methods Over a period of 4 years, patients with SPCMs were treated using a middle versus posterior fossa approach, or a two-stage surgery combining both approaches, based on the tumor location in relation to the petrous ridge and tumor volume. Retrospectively, all cases were analyzed with regard to tumor volume, extent of resection (EOR), functional outcome, and complications.

Results Twenty-seven patients with SPCMs met the inclusion criteria, and the mean follow-up was 24.8 months. Eleven patients underwent a two-stage surgery, while 16 patients had their SPCMs resected via a single craniotomy. Mean EOR was 87.6% and gross total resection was achieved in 48% of patients. Patients with greater EOR had better functional outcomes (r = 0.81, p < 0.01). Greater EOR was not accompanied by a significant increase in surgical complications. There was a trend toward lower postoperative volumes and better EOR with our two-stage approach (2.2 vs. 3.2 cm3, p = 0.09; and 94.1 vs. 91.2%, p = 0.49, respectively), without an increase in the rate of complications (18.7 vs. 18.2%, p = 0.5).

Conclusion Staging of the surgical resection of larger tumors may lead to greater EOR, and this strategy should be considered for larger tumors.

Keywords

petroclival - meningioma - volumetric - extent of resection - outcome - combined approach

Disclosure

The authors of this manuscript do not report any conflict of interest. The work was presented to the investigational review board of our institution, which waved the need for informed consent in view of the retrospective design of the study and the application of strict patient privacy regulations operating in our center.




Publication History

Received: 12 January 2020

Accepted: 22 May 2020

Article published online:
19 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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