Therapeutic Strategy and Long-term Outcome of Meningiomas Located in the Posterior Cranial Fossa

Abstract

The clinical and surgical findings of 41 consecutive cases of posterior cranial fossa meningiomas operated on between January 1987 and December 2011 at Saitama Medical Center/Saitama Medical University were reviewed. The 31 female and 10 male patients were aged from 19 to 74 years (mean 54 years). The tumors were located in the petroclival (N ＝ 15), craniovertebral junction (N ＝ 6), lateral tentorial (N ＝ 12), and cerebellopontine angle (N ＝ 8) regions. Mean tumor equivalent diameter was 4.3 cm (range 2-9 cm). Head pain (46.3%) and gait disturbance (26.8%) were the most common presenting symptoms, and cranial neuropathies were the most common neurological signs on admission. Mean preoperative performance status (Karnofsky scale) was 83% (range 40-100%). Surgical approaches to these tumors included presigmoidal transpetrosal, retrosigmoidal, transcondylar, and combined approaches. In 4 cases, a staged procedure was performed. Gross total resection was achieved in 85.4% of patients, and subtotal/partial resection in 12.2%. Surgical mortality was 2.4% and complications were encountered in 11 patients (26.8%) including temporary neurological deficits in 4 patients. The mean follow-up period was 8.2 years, ranging from 1 to 24 years, and the mean performance status of patients at 12 months after the last surgery was 92% (range 0-100%). Recurrence or progression of disease was found in 9.8% of cases. Postoperative adjuvant therapy was performed in 6 cases. My experience suggests that although posterior cranial fossa meningiomas represent a continuing challenge for contemporary neurosurgeons, such tumors may be completely or subtotally removed with low rate of mortality and acceptable morbidity, allowing most of these patients to achieve good outcome in long-term follow up.

Petroclival Meningiomas: Factors Determining the Choice of Approach

“…►Table 5 shows the comparative results with major surgical series of petroclival meningiomas. 4,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Tumors with extension into the middle fossa, more precisely extending above the tentorium notch, were ap-proached through an access to the lateral skull base. Once the tentorium is completely transected, petrosal approaches provide a better view of the entire tumor extension in a single procedure in cases of real midline retroclival tumors, with supratentorial and middle fossa invasion.…”

Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

“…All rights reserved. 21 3 2018 ---Large-giant tumors >3.5cm in size Javed et al 22 24 1991 ----Nakase et al 23 6 29 4 2012 --Sanna et al 30 2 2007 32, 42 4M/ 9F --Roberti et al 31 38 2001 ----Tsutsui et al 32 1 2016 72 1M -Transitional type Juratli et al 33 1 2015 5 1F -Clear cell meningioma Arivazhagan et al 34 4 2008 ----Wu et al 35 1 2014 22 1M --Aras et al, 36 2 2013 28, 15 2M --Nakamura et al 37 1…”

“…Posterior skull base 1st: Extended middle fossa approach; 2 nd : Retromastoid suboccipital approach Zhao et al 26 Menigiomas located at the anterior portion of the falcotentorial junction -Ahn et al 27 Right temporal fossa -Nakashi ma et al 28 Trigone of the left lateral ventricle 1st: Transylvian approach; 2nd: Transylvian approach; 3rd: high-parietal approach Matsui et al 29 Petroclival 1st: Posterior transpetrosal; 2nd: Lateral suboccipital…”

“…Matsui 29 Giant petroclival tumors with significant suprainfratentorial extension, to minimize the risk of retraction induced brain contusion Difficult-to-Treat Intracranial Meningiomas Gendreau et al…”

Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery–A Systematic Review and Future Perspectives

“…Only two studies (Gantz et al, 1986 ; Raheja et al, 2016 ) report to have achieved complete GTR-rates exclusively via the MCF approach in n = 121 individuals, 34% of which suffered from post-operative FN impairment. Ten studies (Tator and Nedzelski, 1982 ; Kirkpatrick et al, 1993 ; Magliulo et al, 1998 ; Fenton et al, 2002 ; Colletti and Fiorino, 2003 ; Isaacson et al, 2005 ; Neff et al, 2005 ; Esquia-Medina et al, 2009 ; Matsui, 2012 ; Torres et al, 2017 ) report on complete GTR-rates in n = 734 individuals using a selected variation of surgical approaches. About 44% suffered from post-operative FN impairment, with 20% suffering from moderate and 13% from severe FN palsy in patients where information on HB grade was available.…”