Role of surgery for small petrous apex meningiomas causing refractory trigeminal neuropathy in the minimally invasive era

Hegazy, Ahmed; Alfiki, Ahmed; Adel, M; Alsawy, Mohamed F.; Al-Dash, M Fouad; Zein, Mostafa; Amin, Sameh M; Al-Shami, Hieder; Biswas, Anup

doi:10.4103/0028-3886.190230

Cited by 5 publications

(3 citation statements)

References 1 publication

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“…Microsurgery was not only widely used as the primary treatment for intracranial tumors, but also was used to control tumor-related TN with a relatively low complication rate in the past decades [ 13 , 32 , 34 ]. Hegazy et al [ 15 ] selected microsurgery to treat 17 patients with small PAM and secondary refractory TN, and a complete FFP without medication was achieved in 14 patients (82.4%), with very low morbidity, no mortality, and 100% tumor control.…”

Section: Discussionmentioning

confidence: 99%

Drilling off the Petrosal Apex and Opening the Upper Wall of Meckel’s Cave Are the Key Elements of Good Outcomes in the Treatment of Trigeminal Neuralgia Secondary to Petrous Apex Meningioma

Bai

Zhou

Song

et al. 2022

J Korean Neurosurg Soc

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Objective :The surgical management of trigeminal neuralgia (TN) caused by petrous apex meningioma (PAM) is still a challenge because of the lesion's deep location and the surrounding complex structures. The authors describe the intradural anterior transpetrosal approach (ATPA) and its effect on the treatment of TN secondary to PAM. Methods : A retrospective analysis of 15 patients with TN secondary to PAM who underwent surgery via the intradural ATPA was conducted. The key techniques, which included drilling off the petrosal apex (PA) and opening the upper wall of Meckel's cave (MC), are described in detail. Results : Total removal of the tumor and complete pain relief (Barrow Neurological Institute I) were achieved in all 15 patients without significant morbidity. Five patients developed new facial numbness postoperatively, which disappeared within three months after surgery. The postoperative magnetic resonance imaging showed temporal lobe swelling in three patients, but no clinical symptoms. One patient had cerebrospinal fluid leakage and was managed with bed rest and temporary lumbar drainage. One patient had an intracranial infection and was treated with antibiotics. By the last follow up, no patients had pain relapse or/ and tumor recurrence. It is worth noting that the vascular compression at the root of the trigeminal nerve was found in one patient during the operation. Conclusion : Our experience suggests that drilling off the PA and opening the upper wall of the MC are key elements for a good outcome of the treatment of TN secondary to PAM. The intradural ATPA has the advantages for both tumor resection and pain relief.

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Section: Discussionmentioning

confidence: 99%

Drilling off the Petrosal Apex and Opening the Upper Wall of Meckel’s Cave Are the Key Elements of Good Outcomes in the Treatment of Trigeminal Neuralgia Secondary to Petrous Apex Meningioma

Bai

Zhou

Song

et al. 2022

J Korean Neurosurg Soc

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“…For these reasons, GKRS for small PCMs has gained increasing acceptance over the past decade for its acceptable tumor and symptom control, and minimal morbidity rates [13,18,21,27,33]. However, the data of MS for small PCMs with or without TN is scarce [17,31]. In addition, with the data published so far, there is a bias comparing the results of GKRS to MS since the latter have patients with larger tumors.…”

Section: Discussionmentioning

confidence: 99%

“…From 2 to 12% of patients with posterior fossa tumors such as petroclival meningiomas (PCMs) can present with TN by direct compression of the trigeminal nerve root as it enters the brain stem, regardless of tumor size [5,8,20,29,35]. Current treatment options for tumor-induced TN include glycerol rhizotomy, radiofrequency ablation, percutaneous balloon microcompression, gamma knife radiosurgery (GKRS), and microsurgery (MS) when medication alone is insufficient [4,6,10,12,17,18,21,26,33,36]. Direct removal of mass effect by MS seems to be the most logical and effective method to achieve pain control [8,10,18,21], but there is a debate since PCMs have a deep-seated location within the skull base with multitude of critical neurovascular structures surrounding the tumor.…”

Section: Introductionmentioning

confidence: 99%

Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia

et al. 2020

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Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm 3 , respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.

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Endoscopic transorbital route to the petrous apex: a feasibility anatomic study

et al. 2017

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This is the first qualitative and quantitative anatomic study concerning details of the lateral aspect of the incisura and ventrolateral posterior fossa reached via the transorbital window. This manuscript is intended as a feasibility anatomic study, and further clinical contributions are mandatory to confirm the effectiveness of this approach, defining its possible role in the neurosurgical armamentarium.

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Role of surgery for small petrous apex meningiomas causing refractory trigeminal neuropathy in the minimally invasive era

Cited by 5 publications

References 1 publication

Drilling off the Petrosal Apex and Opening the Upper Wall of Meckel’s Cave Are the Key Elements of Good Outcomes in the Treatment of Trigeminal Neuralgia Secondary to Petrous Apex Meningioma

Drilling off the Petrosal Apex and Opening the Upper Wall of Meckel’s Cave Are the Key Elements of Good Outcomes in the Treatment of Trigeminal Neuralgia Secondary to Petrous Apex Meningioma

Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia

Endoscopic transorbital route to the petrous apex: a feasibility anatomic study

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