Jun 18, 2016 petroclival meningiomas pcms are technically challenging lesions. Cranial nerves are at significant risk during the removal of petroclival meningiomas. Pdf endoscopic transsphenoidal surgery for petroclival. Petroclival pc meningiomas are difficulttotreat, deepseated skull base lesions arising from the petroclival synchondrosis with close proximity to vital neurovascular structures. Mar 27, 2020 the topics related to general considerations, clinical presentation, evaluation, and indications for surgery are discussed in the chapter titled petroclival meningioma. It has been successfully applied with acceptable morbidity and mortality rates, mainly for spheno petroclival meningiomas.
Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base. These tumors displace the brain stem and the basilar artery to the opposite side. Petroclival meningiomas were originally considered largely unresectable. The authors report on a series of patients with large and giant skull base meningiomas who were treated with the goal of radical removal. Most studies report that the period of symptoms before diagnosis averages between 2. Outcomes of endonasal and lateral approaches to petroclival. Additionally, the rarity of petroclival meningiomas, variations in treatment philosophies, and heterogeneity in the types of data reported add to the convoluted picture. The petroclival region is a surgical space circumscribed anteriorly by the clivus, laterally by the petrous apex, medially by the brainstem and posteriorly by the internal acoustic canal.
The surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of. This differentiates them from clival meningiomas that arise close to the midline of the clivus. I was just diagnosed with a large petroclival meningioma skull based tumor and i am seeking any advise or guidance you may have to offer. Therapymeningioma factmng, a webbased tumor sitespeci.
Methods between january 1990 and december 2009, 60 consecutive patients with benign who grade i petroclival meningiomas underwent microsurgical resection via a combined transpetrosal approach at osaka city university. May 27, 2014 the surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of these tumors. The postoperative images demonstrate complete resection via the posterior approach. These tumours are most commonly found in middleaged or older people, and in particular in women. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome glasgow outcome scale score 4 or 5 in 92% of patients, although the extent of grosstotal resection was only 28%. There was no difference with respect to immediate postoperative. Treatment usually involves a combination of surgery and radiation treatment.
Petroclival lesions displace the brainstem posteriorly. Petroclival meningioma, recurrenceprogression, surgical treatment, prognostic factors, quality of life, karnofsky performance score introduction petroclival meningiomas account for approximately 310% of posterior fossa meningiomas 1. This case, presented by hallopeau, 8 may represent the first report of a petroclival meningioma in the literature. An update on surgical approaches, decision making, and treatment results article pdf available in neurosurgical focus 356.
Petroclival meningioma, retrosigmoid, skull base, tentorium. Middle cranial fossa surgery tumor removal always dissect tumor medial to lateral prevents disruption of fragile auditory nerve entering cribrosa use fine micro instruments such as 1 2. Factors associated with improved karnofsky performance status. Right a more centrally located petroclival meningioma with lateral extension up to the level of the internal acoustic canal would be better.
Recent surgical results and outcomes mugurel radoi1, florin stefanescu 1, ram vakilnejad 2, lidia gheorghitescu 2, daniela rosu 2 1umf carol davila bucharest. We consider clival and petroclival meningiomas as one entity, because the operative decisionmaking process in treating these two lesions is virtually identical. The prognosis for patients with atypical and malignant meningioma is guarded. Aug 23, 2012 petroclival meningioma decision making dr. These tumors arise along the upper twothirds of the clivus, superior to the jugular foramen and medial to the cranial nerves foramina at the petroclival junction. Large petroclival meningioma with extension into supratentorial space. Petroclival meningiomas are rare and account for less than 2% of all meningiomas. The typical presentation of a petroclival meningioma is that of an insidious onset. The article underscores the importance of neurologic and neuroradiologic examination in diagnosing and managing patients with facial pain conditions. Posterior and anterior petrosectomies petroclival meningiomas are rare and account for less than 2% of all meningiomas. Petroclival meningiomas resected via a combined transpetrosal. These patients require serial mri scans for their entire life.
Total removal of tumor of right retrosigmoid approach using neurophysiologic monitoring. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6. Jun 01, 2016 large petroclival meningioma with extension into supratentorial space. They also represent one of the most controversial entities with regard to approach selec. True petroclival meningiomas dunn laboratory brigham and.
Their management has undergone paradigm shifts over the past few decades that span from radical resection to more tailored surgical decompression that offers. It can be classified according to the location in the posterior fossa into cerebellopontine angle, clival, petroclival, convexity, tentorial and foramen magnum. Petroclival meningiomas still pose a formidable challenge to neurosurgeons. Petroclival meningiomas are vaguely defined as tumours arising from the anteromedial zone to the internal auditory meatus. Full text full text is available as a scanned copy of the original print version. Case discussion meningiomas are the most common extraaxial tumors of the central nervous system. A new scoring system, the petroclival meningioma impairment scale pcmis, was created for quantitative assessment of 8 categories of neurological functions, with scores assigned in each category according to the level of disability and its impact on the patient. Petroclival meningiomas are difficult to treat due to their intimate location with critical structures, and complete microsurgical resection is often associated with significant morbidity. Meningiomas 36 29 iwai y, yamanaka k, yasui t, komiyama m, nishikawa m, nakajima h, kishi h. Petroclival meningioma, surgical approach, skull base surgery, results of microsurgical management. Group apatients cases have been operated on using mostly either a subtemporal trans tentorial or a retrosigmoid approach.
This study investigated the association between gross total resection gtr and allcause mortality in patients with atypical and malignant meningioma. Although the standard retrosigmoid approach is one of the most effective approaches, this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa. All uploads and downloads are deemed secure and files are permanently deleted from the smallpdf servers within an hour. Posterior fossa meningioma surgical experiences sciencedirect. Soda pdf merge tool allows you to combine two or more documents into a single pdf file for free. Methods thirtyone cases of petroclival meningioma have been operated on during a 4year period using two different philosophies as far as the approach. Left petroclival meningioma, with intraosseous extension into left petrous apex. Drainage patterns of the superficial middle cerebral vein. These tumors are deep in the base of the skull and arise medial to the fifth cranial nerve. Reports in the literature of surgical outcomes in petroclival meningiomas. Petroclival meningioma skull based tumor looking for. Get a printable copy pdf file of the complete article 2. Nerve deficits after petroclival meningioma surgery inspire. Petroclival meningiomas are slowgrowing tumors that usually produce clinical symptoms after reaching large size.
Petroclival meningioma skull based tumor looking for some. Retrosigmoid transtentorial resection of a petroclival meningioma. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. Ninetyone patients with petroclival meningioma underwent surgery via the anterior transpetrosal approach. In addition, the general resection techniques for removal of petroclival meningiomas. Original article factors associated with improved karnofsky.
The goal of petroclival meningioma surgery is complete tumor removal, if possible, and to accomplish this without creating a functional decline of the patient. How to combine pdf files into one document lifewire. The advent of microsurgical techniques has allowed some master surgeons to report very encouraging results of. Retrosigmoid approach for resection of petroclival meningioma. A meningioma is a type of tumour that grows from the protective canvaslike membrane called the meninges covering of the brain and spinal cord. Preoperative nf and postoperative lower row mr images demonstrating a large petroclival meningioma extending below the iam in a patient with intact hearing, prompting a posterior petrosal approach for resection. Petroclival meningioma presenting with pathological. We surveyed the relevant literature available on intracranial meningioma surgery and subsequent outcomes 38 papers, making note of which, if. In the rest of 6 patients, a partial removal of the meningioma was performed simpson grade iv. Petroclival meningiomas, by definition, are tumors that originate in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve.
Petroclival meningiomas are challenging lesions to manage independently of the selected surgical approach and are unique tumors in the type of. However, in many patients, tumor has to be left behind in the cs, around cranial nerves or the arteries, or when invading the brainstem pial plate. The large and giant skull base meningiomas are challenging lesions, and the involvement of crucial neurovascular structures needs the surgical removal as the primordial treatment. We provide a modified surgical technique called retrosigmoidtranstentorial approach rtta to solve these problems. Meningiomas of the clivus have been traditionally considered an almost prohibitive surgical challenge 4,5,7,11,14. The authors surgical removal of small petroclival meningiomas 439 responses is quite clear, and i tend to agree with them. It seems doubtful whether radical surgical removal should always be the primary goal in those lesions as advocated until very recently. Retrosigmoidtranstentorial approach for petroclival. The trochlear nerve is often injured due to its size and fragility. Rearrange individual pages or entire files in the desired order. However, it is clear that the development of microsurgical techniques and skull base approaches. Before you combine the files into one pdf file, use merge pdf to draganddrop pages to reorder or to delete them as you like. Petroclival meningioma had all postoperative complication items and all the postoperative mortality cases. Extended middle fossa approach with anterior petrosectomy.
Pdf merge combinejoin pdf files online for free soda pdf. The treatment is tailored to the size and extent of disease with consideration given to the health of the patient. From what i have been able to research, this is a rare tumor that is located in a very bad location as it is right were all of the cranial nerves and arteries are located at the base of the skull. Fifty patients underwent surgical treatment for petroclival meningiomas. Meningioma is a common tumor that represents about 30% of all intracranial tumors. Petroclival meningioma is a deep tumor in the posterior fossa lying in front of the brain stem which can be injured either directly or indirectly through vascular injury causing several complications. The surgical management of petroclival meningiomas is, despite the invaluable technical achievements in the past decade, still burdened by a high operative morbidity. Petroclival meningioma presenting with pathological laughter.
Your story matters citation bi, wenya linda, michael zhang, winona w. Get a printable copy pdf file of the complete article 1. Petroclival meningioma, recurrenceprogression, surgical treatment. Some patients have no symptoms at all, and others may have headaches, double vision, facial numbness, hearing loss, andor dizziness. Extent of resection and overall survival for patients with. Petroclival meningiomas neurosurgery oxford academic. Surgical management of petroclival meningiomas clinical gate. Pdf the surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome glasgow otcome scale score 4 or 5 in 92% of patients, although the extent of grosstotal resection was only 28%. In the past, petroclival meningiomas were described only in postmortem studies. Tumor progression following petroclival meningioma subtotal. Petroclival meningiomas diagnosis, treatment, and results. This video describes the classic retrosigmoid approach for the resection of petroclival lesions.
One study has investigated postoperative growth rates following subtotal resection of petroclival meningiomas. Presigmoid sinus approach to petroclival meningiomas ncbi nih. As mentioned, perforators from the basilar artery can be quite difficult to identify and separate from the tumor, particularly when a large petroclival meningioma encases the basilar artery. It goes from the dorsum sellae to the foramen jugularis. Petroclival meningiomas are surgically challenging tumors due to the proximity to cranial nerves, major blood vessels, and the brainstem with considerably high. The topics related to general considerations, clinical presentation, evaluation, and indications for surgery are discussed in the chapter titled petroclival meningioma.
Further improvement in the management of petroclival meningiomas has been achieved with microsurgery combined with cranial base approaches 1, 2, 1620, 23, 24, 29, 3238, 41. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3. Soda pdf merge tool allows you to combine two or more documents into a single pdf file. In the present study, no petroclival meningioma cases in which the smcv connected with the cavernous sinus manifested any complications of pre, intra, or postoperative management of surgical treatment. Pdf surgical removal of small petroclival meningiomas. The surgical management of petroclival meningiomas remains a formidable challenge. A meningioma is a tumor that grows from the dura membrane blue covering the brain and spinal cord. This report subclassifies petroclival meningiomas based on their origin determined by using radiological and intraoperative findings. Neurosurgical department of the national institute of neurology and neurovascular diseases bucharest. During a year period 19912004, 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. Grade iii, malignant meningiomas are the most aggressive and are called anaplastic. Petroclival meningioma arises in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve.
Tumors extended into adjoining regions in 57% of the patients. In this operative video, the author demonstrates the extended middle fossa approach with anterior petrosectomy to resect an upper petroclival meningioma extending into. True petroclival meningiomas 41 medial to the fifth cranial nerve cn v and consider these true petroclival meningiomas for their distinct clinical and outcome considerations. Petroclival meningiomas may be in the posterior fossa alone, or may span the middle and posterior cranial fossae. Left petroclival meningioma with wide dural base across the petrous ridge with extension to the cerebellopontine angle and invasion of the internal acoustic canal would be an approached via rsa. Diagnostic, prognostic, and therapeutic applications the harvard community has made this article openly available.
660 304 397 1241 286 1382 587 980 1294 413 79 847 989 933 525 1178 784 1050 625 394 1285 84 872 751 410 330 205 1059 1268 818 1027 275 868 38 173 229 1192