The algorithm for surgical treatment of skull base tumors invading the craniovertebral junction

An, Shkarubo; Dn, Andreev; Na, Konovalov; Ay, Lubnin; Pv, Zelenkov; Am, Turkin; Ba, Kadashev; Dv, Sidorkin; Ia, Voronina; Kv, Koval'; Vv, Karnaukhov

doi:10.17116/neiro201680221-34

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Staged resection can be performed for some tumors with a wide range of growth. Recently, some neurosurgeons have tried simultaneous combined surgery, combining transnasal and transcranial approaches with endoscopy, which can improve the safety and timeliness of surgery ( 28 , 29 ). Moreover, intraoperative vascular ultrasound, neuronavigation, and neuroelectrophysiological monitoring can improve the accuracy and safety of surgery ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma

et al. 2021

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Background: Skull base chordoma is a rare tumor with low-grade malignancy and a high recurrence rate, the factors affecting the prognosis of patients need to be further studied. For that, we investigated prognostic factors of skull base chordoma through the database of the Surveillance, Epidemiology, and End Results (SEER) program, and validated in an independent data set from the Xiangya Hospital.Methods: Six hundred and forty-three patients diagnosed with skull base chordoma were obtained from the SEER database (606 patients) and the Xiangya Hospital (37 patients). Categorical variables were selected by Chi-square test with a statistical difference. Survival curves were constructed by Kaplan–Meier analysis and compared by log-rank test. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors. Propensity score matching (PSM) analysis was undertaken to reduce the substantial bias between gross total resection (GTR) and subtotal resection (STR) groups. Furthermore, clinical data of 37 patients from the Xiangya Hospital were used as validation cohorts to check the survival impacts of the extent of resection and adjuvant radiotherapy on prognosis.Results: We found that age at diagnosis, primary site, disease stage, surgical treatment, and tumor size was significantly associated with the prognosis of skull base chordoma. PSM analysis revealed that there was no significant difference in the OS between GTR and STR (p = 0.157). Independent data set from the Xiangya Hospital proved no statistical difference in OS between GTR and STR groups (p = 0.16), but the GTR group was superior to the STR group for progression-free survival (PFS) (p = 0.048). Postoperative radiotherapy does not improve OS (p = 0.28), but it can prolong PFS (p = 0.0037). Nomograms predicting 5- and 10-year OS and DSS were constructed based on statistically significant factors identified by multivariate Cox analysis. Age, primary site, tumor size, surgical treatment, and disease stage were included as prognostic predictors in the nomograms with good performance.Conclusions: We identified age, tumor size, surgery, primary site, and tumor stage as main factors affecting the prognosis of the skull base chordoma. Resection of the tumor as much as possible while ensuring safety, combined with postoperative radiotherapy may be the optimum treatment for skull base chordoma.

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Section: Discussionmentioning

confidence: 99%

Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma

et al. 2021

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“…Based on literature, the progression or recurrence rate of pineal region meningiomas varies from 0-66.7% [2,4,6,7,15,[17][18][19][20][21][22]. Similarly, the tumor progression rate was 10.0% in our series.…”

Section: Surgical Strategies and Long-term Outcomesmentioning

confidence: 56%

“…Considering this invasion rate, we ultimately obtained a GTR rate of 73%. GTR rates reported in prior literature exhibit signi cant variability, with a range of 25.0-100% [2,4,6,7,[15][16][17][18][19][20][21][22]. The higher GTR rates reported in earlier literature may stem from the evaluation criteria being based on the surgeon's impression or postoperative CT review.…”

Section: Surgical Resectability and Short-term Postoperative Outcomesmentioning

confidence: 99%

“…In fact, the treatment approach for meningiomas is shifting from total resection to more conservative treatment, that is, stereotactic radiosurgery and / or radiotherapy after subtotal resection, rather than radical treatments that may put important neurovascular structures at unacceptable risk [15]. The mortality and permanent disability rates reported in the previous literature were 0-23.0% and 20.0-55.6%, respectively [2,4,6,7,[15][16][17][18][19][20][21][22]. The surgical mortality rate in our series was 5.4%, all of which occurred in patients who underwent GTR.…”

Section: Surgical Resectability and Short-term Postoperative Outcomesmentioning

confidence: 99%

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Twelve-year experience of pineal region meningiomas: Long-term outcomes of maximal safe resection

He,

Chen,

et al. 2024

Preprint

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Purpose The purpose of this research was to summarize the clinical and prognostic features of penial region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of penial region meningiomas. Methods We retrospectively studied the data of 37 patients who received surgical resection for penial region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for penial region meningiomas. Results The most common symptom was intracranial hypertension associated with obstructive hydrocephalus (75.7%). The Poppen approach (40.5%) and Krause approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10%, the 5-year PFS rate was 92.9%, and the ΔKPS was 15.3. Multivariate analysis revealed that the STR+GKRS and Krause approach were beneficial to the recovery of quality of life of patients. Conclusion Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients.

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Surgical and combined treatment of patients with craniovertebral junction meningioma: a single-center retrospective study of 196 cases

et al. 2023

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The algorithm for surgical treatment of skull base tumors invading the craniovertebral junction

Cited by 5 publications

References 14 publications

Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma

Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma

Twelve-year experience of pineal region meningiomas: Long-term outcomes of maximal safe resection

Surgical and combined treatment of patients with craniovertebral junction meningioma: a single-center retrospective study of 196 cases

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