Petroclival meningiomas: radiological features essential for surgeons

Nicosia, Luca; Pietro, Salvatore Di; Catapano, Michele; Spadarella, Gaia; Sammut, Lara; Cannataci, Christine; Resta, F.; Reganati, Paolo

doi:10.3332/ecancer.2019.907

Cited by 9 publications

(6 citation statements)

References 42 publications

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“…Thin-slice MRI is required to observe the anatomical relationship between the tumor, IAC, and Dorellos canal. Fast imaging employing steady-state acquisition or proton density-weighted MRI could be helpful as a representative imaging protocol (33,34). Thin-slice MRI allows good observation of the interdural segment of Dorello canal (34).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas

Yoo¹,

Lim²,

Jung³

et al. 2021

Journal of Neuro-Ophthalmology

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Background:During the surgical resection of petroclival meningiomas, preserving the cranial nerves is crucial. The abducens nerve is particularly vulnerable during surgery. However, the preoperative risk factors and postoperative prognosis of abducens nerve palsy (ANP) are poorly understood.Methods:We retrospectively analyzed 70 patients who underwent surgery for petroclival meningiomas between May 2010 and December 2019, divided into gross-total resection (GTR) and subtotal resection (STR) groups. The relationship of preoperative clinical factors with the incidence and recovery of postoperative ANP was analyzed.Results:Postoperative ANP was observed in 23 patients (32.9%). Multivariable logistic regression revealed that the tumor-to-cerebellar peduncle T2 imaging intensity index (TCTI) (P < 0.001) and internal auditory canal invasion (P = 0.033) contributed to postoperative ANP. GTR was achieved in 37 patients (52.9%), and 10 (27.0%) of them showed ANP. STR was achieved in 33 patients (47.1%), and 13 (39.4%) of them showed ANP. Recovery from ANP took a median of 6.6 months (range, 4.5–20.3 months). At 6 months after the operation, recovery of the abducens nerve function was observed in 16 patients (69.0%); of whom, 4 (40.0%) were in the GTR group and 12 (92.3%) were in the STR group (P = 0.025).Conclusions:TCTI and internal auditory canal invasion were the risk factors for postoperative ANP. Although intentional STR did not prevent ANP immediately after the operation, recovery of the abducens nerve function after surgery was observed more frequently in the STR group than in the GTR group.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas

Yoo¹,

Lim²,

Jung³

et al. 2021

Journal of Neuro-Ophthalmology

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“…The appropriate treatment of PCM is a matter of debate [2][3][4][5][6][7][8][9][10][11][12][13][14]. The risk of postoperative neurological deficits is high [2,13,[19][20][21][22][23][24][25][26][27][28]. Besides surgery alternative treatments are considered like radiation or observation [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…The signal in T2-weighted images (T2 relaxation time) was correlated with the intraoperative tumor consistency. In comparison with the intensity of the normal cortex, firm tumors were reported to have a lower intensity on T2-weighted images, whereas soft tumors are hyperintense [ 21 ]. The assessment was performed by two independent clinically experienced neuroradiologists (D.D.…”

Section: Methodsmentioning

confidence: 99%

Surgical results of 158 petroclival meningiomas with special focus on standard craniotomies

et al. 2022

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Objective The goal of this retrospective study is the evaluation of risk factors for postoperative neurological deficits after petroclival meningioma (PCM) surgery with special focus on standard craniotomies. Materials and methods One-hundred-fifty-eight patients were included in the study, of which 133 patients suffered from primary and 25 from recurrent PCM. All patients were operated on and evaluated concerning age, tumor size, histology, pre- and postoperative cranial nerve (CN) deficits, morbidity, mortality, and surgical complications. Tumor-specific features—e.g., consistency, surface, arachnoid cleavage, and location—were set in a four-grade classification system that was used to evaluate the risk of CN deficits and tumor resectability. Results After primary tumor resection, new CN deficits occurred in 27.3% of patients. Preoperative ataxia improved in 25%, whereas 10% developed new ataxia. Gross total resection (GTR) was achieved in 59.4%. The morbidity rate, including hemiparesis, shunt-dependence, postop-hemorrhage, and tracheostomy was 22.6% and the mortality rate was 2.3%. In recurrent PCM surgery, CN deficits occurred in 16%. GTR could be achieved in three cases. Minor complications occurred in 20%. By applying the proposed new classification system to patients operated via standard craniotomies, the best outcome was observed in type I tumor patients (soft tumor consistency, smooth surface, plane arachnoid cleavage, and unilateral localization) with GTR in 78.7% (p < 0.001) and 11.9% new CN deficits (p = 0.006). Conclusion Standard craniotomies as the retrosigmoid or subtemporal/pterional approaches are often used for the resection of PCMs. Whether these approaches are sufficient for GTR—and avoidance of new neurological deficits—depends mainly on the localization and intrinsic tumor-specific features.

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“…Tumor adherence could be seen as destruction of the arachnoidal plane on T1-weighted magnetic resonance images. 21 Brainstem compression and edema formation contribute to surgery difficulty. Resection of tumor adhering to the brainstem is not advisable as it may harm the perforating branches from the vertebrobasilar artery to the brainstem.…”

Section: Discussionmentioning

confidence: 99%

Modified Transpetrosal–Transtentorial Approach for Resection of Large and Giant Petroclival Meningioma: Technical Nuance and Surgical Experiences

Haq

Wahyuhadi

Suryonurafif

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Meningiomas arising from the petroclival area remain a challenge for neurosurgeons. Various approaches have been proposed to achieve maximum resection with minimal morbidity and mortality. Also, some articles correlated preservation of adjacent veins with less neurologic deficits. Objective To describe the experiences in using a new technique to achieve maximal resection of petroclival meningiomas and preserving the superior petrosal veins (SPVs) and the superior petrosal sinus (SPS). Methods A retrospective analysis of 26 patients harboring a true petroclival meningioma with a diameter ≥25 mm and undergoing surgery with the modified transpetrosal–transtentorial approach (MTTA) was performed. Results Fifty-four percent of 22 patients complained of severe headache at presentation. There was also complaint of cranial nerve (CN) deficit, with CN VII deficit being the most common (present in 42% of patients). The average tumor size (measured as maximum diameter) was 45.2 mm, and most of the tumors compressed the brainstem. Total resection was achieved in 12 patients (46.2%), whereas the others were excised subtotally (54.8%). Most of the patients had WHO grade I (96.1%) meningioma; only one had a grade II (3.8%) meningioma. In addition, clinical improvement and persistence of symptoms were observed in 17 (65.4%) and 8 (30.7%) patients, respectively, and postoperative permanent CN injury was observed in 3 (11.5%) patients. Conclusion Using the MTTA, maximal resection with preservation of the CNs and neurovascular SPV-SPS complex can be achieved. Therefore, further studies and improvements of the technique are required to increase the total resection rate without neglecting the complications that may develop postoperatively.

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Petroclival meningiomas: radiological features essential for surgeons

Cited by 9 publications

References 42 publications

Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas

Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas

Surgical results of 158 petroclival meningiomas with special focus on standard craniotomies

Modified Transpetrosal–Transtentorial Approach for Resection of Large and Giant Petroclival Meningioma: Technical Nuance and Surgical Experiences

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