Surgical Management of Clival Meningiomas

Javed, Tariq; Sekhar, Laligam N.

doi:10.1007/978-3-7091-9183-5_28

Cited by 47 publications

(24 citation statements)

References 14 publications

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“…In contrast to other skull base approaches, such as anterior, anterolateral, and posterolateral routes, which are routinely described for accessing extraaxial lesions ventral to the brainstem, 3,7,8,15,23,24,27,28,36,41,43,49,52,53,56,[59][60][61][62]64 the endonasal approach to the clival area has been used historically only to remove clival chordomas. 13,39,45,46 The bone destruction related to the chordoma often creates the surgical pathway, and its location is often purely anterior, making the transsphenoidal approach less difficult.…”

Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

“…As a result of these advantages it offers a lower morbidity and mortality rate when compared with transcranial procedures, and this also naturally leads to a shorter hospital stay. Nevertheless, a variety of innovative skull base approaches (including anterior, anterolateral, and posterolateral routes, which often require extensive neurovascular manipulation to gain access to the lesion) have been developed to allow resection of extraaxial lesions of the anterior skull base or lesions ventral to the brainstem 3,7,8,15,18,[20][21][22][23][24][26][27][28]36,41,43,49,52,53,56,[59][60][61][62]64 that are outside of the sella or immediate parasellar area. These approaches have often been used alone or in combination as staged approaches for extensive tumors.…”

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confidence: 99%

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Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

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Object The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable. Conclusions The major potential advantage of the endoscopic endonasal approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an anteromedial approach. Potential disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with cerebrospinal fluid (CSF) leakage and potential for meningitis resulting. These approaches often require a large opening of the dura mater over the tuberculum sellae and posterior planum sphenoidale, or retroclival space. In addition, they typically involve large intraoperative CSF leaks, which necessitate precise and effective dural closure.

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Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

View full text Add to dashboard Cite

show abstract

“…Even with the advancement of skull base surgery, these lesions still have the highest rate of incomplete removal, ranging from 26% to 75% with a high rate of postoperative complications reaching up to 50%. 4,16,[25][26][27] Adherence to neurovascular structures and extradural bone invasion were the most important obstacles for achieving total removal. 4,24 We used the modified TC approach for all cases of large petroclival meningiomas irrespective of the preoperative hearing.…”

Section: Posterior Fossa Men Ingioma-saleh Et Almentioning

confidence: 99%

Posterior Fossa Meningioma: Surgical Strategy

Saleh¹,

Taibah²,

Achilli³

et al. 1994

Skull Base

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“…In 1991, Kawase et al reported on a series of ten patients with sphenopetroclival meningiomas on whom they used the anterior transpetrosaltranstentorial approach; total resection was achieved in 7 patients with no postoperative mortality (11). Based on a series of 52 patients with petroclival meningiomas, Sekhar and Javid (9) reported in 1991 their results using a variety of skull base approaches. They achieved total tumor resection in 38 cases (73%), subtotal resection in 11 (21%), and partial resection in 3 (6%) with 2 postoperative mortalities.…”

Section: Discussionmentioning

confidence: 99%

Surgery of petroclival meningiomas. Recent surgical results and outcomes

Rădoi¹,

Stefanescu²,

Vakilnejad³

et al. 2015

Romanian Neurosurgery

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Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. We described our recent experience (2005 regarding the surgery of these tumors. We retrospectively analyzed surgical results and outcome in 11 cases of petroclival meningiomas. Most common symptoms in our series were headache and gait disturbance, while cranial nerves palsies represented the most common presenting signs. There were 8 females and 3 males, and the mean age was 52 years. Surgical approaches chosen for petroclival meningiomas in our series were retrosigmoid (9 patients) and subtemporal transtentorial (2 patients). We achieved total tumor resection in 5 cases (45%) and subtotal resection in 6 cases (55%). Overall outcome (total/subtotal resection) was good in 6 cases, fair in 3 cases and poor in one case. One postoperative death occurred due to hemorrhagic midbrain infarction (9%). Complications were usually related to cranial nerve deficits: loss of hearing (2 patients), paresis of trochlear nerve (1 patient), trigeminal nerve (3 patients) and facial nerve (1 patient). In 4 patients these cranial nerves deficits were transient. In one case, a patient developed postoperative hydrocephalus and needed shunt placement. Despite the fact that complications can be disastrous, we considered that an appropriate approach, combined with microsurgical techniques and a better understanding of the anatomy, greatly decrease the incidence and severity of complications and make feasible a total tumor resection.

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Surgical Management of Clival Meningiomas

Cited by 47 publications

References 14 publications

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Posterior Fossa Meningioma: Surgical Strategy

Surgery of petroclival meningiomas. Recent surgical results and outcomes

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