The retrosigmoid approach to petroclival meningioma surgery

Chen, Lifeng; Yu, Xin-guang; Bai, Bo; Xu, Bainan; Zhou, Ding-biao

doi:10.1016/j.jocn.2011.03.027

Cited by 39 publications

(19 citation statements)

References 28 publications

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“…8,9 The conventional retrosigmoid approach has been used for lesions with significant mass in the posterior fossa and involving the cerebellopontine angle. 6,10,12,17,46,48 A modified approach, retrosigmoid intradural suprameatal approach, includes a retrosigmoid craniotomy and intradural drilling of the bone located above and anterior to the IAC. 49 The retrosigmoid intradural suprameatal approach is suitable for lesions mainly in the posterior fossa with some extension through Meckel's cave into the middle fossa.…”

Section: Surgical Approachesmentioning

confidence: 99%

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Karampelas

Megerian³

et al. 2013

FOC

102

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Object Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base and proximity to eloquent neurovascular structures. Various skull base approaches have been used in their treatment, and deciding which is the optimal one remains controversial. Attempts at achieving gross- or near-total resections are associated with an increased rate of morbidity and mortality. As adjunctive treatment options such as stereotactic radiosurgery have been developed and become widely available, there has been a trend toward accepting subtotal resections in an effort to minimize neurological morbidity. This paper reviews a recent series of patients with petroclival meningiomas and highlights current management trends and important considerations useful in surgical decision making. Methods The records of patients with large (> 3 cm) petroclival meningiomas surgically treated by the senior author over the past 5 years were reviewed. The clinical results are presented as examples of the surgical approaches available for approaching these tumors, and treatment options are reviewed. Results Of 196 meningiomas surgically treated during the study period, 8 lesions in 8 patients met the study criteria. Overall clinical results were excellent, with no death or major morbidity. Intracranial gross- or near-total resection (Simpson Grade 1, 2, or 3) was achieved in 5 patients (67%). New cranial nerve deficits occurred in 3 patients (37%) and were more common in patients in whom a subtotal resection was performed (2 of 3 cases). A variety of surgical approaches were used. Important considerations determining the best approach include the location of the tumor relative to the internal auditory canal, the presence of preoperative hearing loss, and the location of the tumor relative to the tentorium. Conclusions Achieving gross- or near-total resections of large petroclival meningiomas remains achievable and should be the primary goal of surgical treatment. A retrosigmoid craniotomy remains a workhorse surgical approach for most petroclival tumors of any size. Tumors that are medial to the internal auditory canal and span both middle and posterior cranial fossae are often best treated with a combined transpetrosal approach, which is especially true if there is a preoperative hearing deficit.

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Section: Surgical Approachesmentioning

confidence: 99%

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Karampelas

Megerian³

et al. 2013

FOC

102

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“…Similarly, the combined transpetrosal approach which was once considered to be the first option for PCMs [16] can provide a much wider vision and shorter distance to access to the petroclival area, when they significantly grow into both the middle and posterior fossae equally. Besides the disadvantages similar to a presigmoid transpetrosal approach it also increases a potential risk of damage to the facial nerve, hearing loss, and injury to the vein of Labbe [20] which lead to slow recovery and poor neurological outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages are obvious including: 1) Less trauma to patient, simpler approach for operator and less time consumption [18]. 2) Avoiding the injury of the traction of vein of Labbe and decreasing the iatrogenic complications [13,20]. 3) More abundant exposure of operative sight without more traction of cerebellum and venous sinus handling [20] to expose the deep regions of superior petrosal sinu, petrous apex, edge of tentorium and clivus and if needed, accompany with the incising of tentorium, the exposure can be extended to the whole region of clivus from dorsum sellae to foramen magnum region.…”

Section: Discussionmentioning

confidence: 99%

“…2) Avoiding the injury of the traction of vein of Labbe and decreasing the iatrogenic complications [13,20]. 3) More abundant exposure of operative sight without more traction of cerebellum and venous sinus handling [20] to expose the deep regions of superior petrosal sinu, petrous apex, edge of tentorium and clivus and if needed, accompany with the incising of tentorium, the exposure can be extended to the whole region of clivus from dorsum sellae to foramen magnum region. 4) Earlier exposure and handling of brain-tumor boundary and basement of tumor without necessarily extensive resection of the petrous bone, drilling of the suprameatal bone and exposing the internal structures of petrosal bone [13].…”

Section: Discussionmentioning

confidence: 99%

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Retrosigmoid-transtentorial approach for petroclival meningiomas: operative technique and clinical outcome

Zhao

Yuan

et al. 2016

Chin Neurosurg Jl

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Background: Petroclival meningiomas (PCMs) are technically challenging lesions. 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. We provide a modified surgical technique called retrosigmoid-transtentorial approach (RTTA) to solve these problems. The feasibility and efficacy of the RTTA were studied, by analyzing neurological outcomes and considerations of surgical strategies. Methods: We analyzed 64 of 71 PCM patients (90.1 %). All 64 patients had epicenter of tumor in the posterior fossa with varying degrees of extension into the supratentorial area and/or the middle fossa. A conventional retrosigmoid craniotomy was performed following which the tentorium was incised from the attachment of tumor toward the free edge, which improved exposure to the petroclival region by offering additional operative room without resection of the adjacent part of the petrous bone. Results: The rate of gross total resection was 71.9 %. There was no incidence of intraoperative death. One patient died in the postoperative phase. The postoperative permanent morbidity rate was 25.4 %. Follow-up was done with the mean time of 60.7 ± 47.5 months. There were 6 recurrence, 8 progression and 7 death cases and the mean KPS score was 83.2 ± 13.4 in the last follow up. Conclusions: The RTTA achieves the goal of applying a safe, quick, uncomplicated, and lesser invasive access to the petroclival region which is indicated for tumors located in the posterior fossa with some extension into the supratentorial area and/or the middle fossa.

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“…The suboccipital retrosigmoid approach was widely used to manipulate lesions in cerebellopontine angle and lower clivus (7,23). However, tumor removal had to be performed through the interspace of VII-XII cranial nerves.…”

Section: Study Limitationsmentioning

confidence: 99%

Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

Tang

Wang²,

Ma³

et al. 2014

Turkish Neurosurgery

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AIm:The anatomic characters and applicability of the extended pterional transtemporal transtentorial (EPTT) approach versus the subtemporal transtentorial (ST) approach for surgical treatment of petroclival tumors were evaluated. mATErIAl and mEThOds: Ten sides from five adult Chinese injected cadavers were manipulated using both two approaches. Four deep bony anatomic landmarks were specified in the skull base to create two adjoining triangles that were respectively located in the anterior and posterior petroclival region. The real, projected area and the percentage of the projected area were determined and calculated to compare the deep exposure from the two approaches.rEsulTs: There was no difference regarding the percentage of the projected area was calculated in the anterior triangles (EPTT, 21.5±12.5%; ST, 28.8±14.9%; p=0.1948), but a significant difference was present in the posterior triangles (EPTT, 74.0±4.5%; ST, 51.5±4.3%; p<0.01). Compared with the ST approach, the EPTT approach provides an equivalent percentage of projected area in the middle cranial fossa and a wider exposed area in the posterior cranial fossa. CONClusION:Through anatomic comparative analysis the EPTT approach provides better exposure and is more appropriate than the ST approach for large and giant petroclival tumors predominantly in the posterior cranial fossa with extensive invasion to parasellar structures and the cavernous sinus.KEywOrds: Anatomic study, Petroclival region, Pterional approach, Subtemporal approach, Skull base ÖZ AmAÇ: Petroklival tümörlerin cerrahi tedavisi için genişletilmiş pterional transtemporal transtentorial (EPTT) yaklaşımı ile subtemporal transtentorial (ST) yaklaşımının anatomik özellikleri ve uygulanabilirliği karşılaştırmalı olarak değerlendirildi. yÖNTEm ve GErEÇlEr: Her iki yaklaşım kullanılarak beş yetişkin Çinli kadavra çift taraflı olarak açıldı ve incelendi. Kafa tabanında sırasıyla anterior ve posterior petroklival bölgede bulunan yan yana iki üçgen oluşturmak üzere dört adet derin kemik anatomik referans noktası belirlendi. İki yaklaşımın sağladığı derin ekspojuru karşılaştırmak üzere gerçek, projeksiyon yapılmış alan ve projeksiyon yapılmış alanın yüzdesi belirlendi ve hesaplandı.BulGulAr: Ön üçgenler için hesaplanan projeksiyon alanı yüzdesinde bir fark görülmedi (EPTT, %21,5±12,5; ST, %28,8±14,9; p=0,1948) ama arka üçgenler için önemli bir fark bulundu (EPTT, %74,0±4,5; ST, %51,5±4,3; p<0,01). ST yaklaşımıyla karşılaştırıldığında EPTT yaklaşımı orta kraniyal fossada eşdeğer projeksiyon yapılmış alan yüzdesi ve posterior kraniyal fossada daha büyük bir açığa çıkarılmış alan sağladı. sONuÇ: Karşılaştırmalı analiz yoluyla EPTT yaklaşımının temel olarak posterior kraniyal fossada bulunan ve parasellar yapılar ve kavernöz sinüse yaygın invazyon yapmış büyük ve dev petroklival tümörler için ST yaklaşımına göre daha fazla görüş alanı sağladığı ve daha uygun olduğu ortaya çıktı.

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The retrosigmoid approach to petroclival meningioma surgery

Cited by 39 publications

References 28 publications

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Retrosigmoid-transtentorial approach for petroclival meningiomas: operative technique and clinical outcome

Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

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