Transmastoid Retrosigmoid Approach to the Cerebellopontine Angle

Abolfotoh, Mohammad; Dunn, Ian F.; Al‐Mefty, Ossama

doi:10.1227/neu.0b013e31827fc87b

Cited by 21 publications

(35 citation statements)

References 28 publications

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“…17 Alternatively, a transmastoid retrosigmoid approach may need to be adopted to avoid injury to critical draining veins. 2 We believe that skull base approaches not only facilitate an improved chance of complete removal but also lessen the risk of morbidity, including cranial nerve deficits. However, their performance mandates a longer operative time than conventional approaches.…”

Section: Surgery: Approachesmentioning

confidence: 99%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

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135

121

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Object The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. Methods The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O.A.) from 1988 to 2012, strictly defined as those originating medial to the fifth cranial nerve on the upper two-thirds of the clivus. The patients' average age was 49 years; the average tumor size (maximum diameter) was 35.48 ± 10.09 mm (with 59 tumors > 20 mm), and cavernous sinus extension was present in 39 patients. The mean duration of follow-up was 71.57 months (range 4–276 months). Results In 42 patients, the operative reports allowed the grading of resection. Grade I resection (tumor, dura, and bone) was achieved in 17 patients (40.4%); there was no recurrence in this group (p = 0.0045). Grade II (tumor, dura) was achieved in 15 patients (36%). There was a statistically significant difference in the rate of recurrence with respect to resection grade (Grades I and II vs other grades, p = 0.0052). In all patients, tumor removal was classified based on postoperative contrast-enhanced MRI, and gross-total resection (GTR) was considered to be achieved if there was no enhancement present; on this basis, GTR was achieved in 41 (64%) of 64 patients, with a significantly lower recurrence rate in these patients than in the group with residual enhancement (p = 0.00348). One patient died from pulmonary embolism after discharge. The mean Karnofsky Performance Status (KPS) score was 85.31 preoperatively (median 90) and improved on follow-up to 88, with 30 patients (47%) having an improved KPS score on follow-up. Three patients suffered a permanent deficit that significantly affected their KPS. Cerebrospinal fluid leak occurred in 8 patients (12.5%), with 2 of them requiring exploration. Eighty-nine percent of the patients had cranial nerve deficits on presentation; of the 54 patients with more than 2 months of follow-up, 21 (32.8%) had persisting cranial nerve deficits. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6.2%. There was no difference with respect to immediate postoperative cranial nerve deficit in patients who had GTR compared with those who had subtotal resection. Conclusions Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.

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Section: Surgery: Approachesmentioning

confidence: 99%

True petroclival meningiomas: results of surgical management

Almefty

Dunn

Pravdenkova³

et al. 2014

JNS

Self Cite

135

121

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“…In literature, GTR rates range from 27.5 to 86.1%. 3,[6][7][8]12,17,18,20,24 In the current series, we achieved GTR in 22 individuals (78.5%; ►Fig. 1F, 2C, 3B; ►Table 3).…”

Section: Mortality Morbidity Extension Of Resection and Recurrencementioning

confidence: 47%

“…Death rates have declined since then. 3,4,6,11,12,18,20 The operative mortality in this series was 3.5% (one patient). Yasargil et al, 11 Samii et al, 12 Malis, 18 and others [3][4][5] advocate that the ideal management of CPA meningiomas is GTR.…”

Section: Mortality Morbidity Extension Of Resection and Recurrencementioning

confidence: 65%

“…Compared with the classical retrosigmoid approach, the extended retrosigmoid approach, with additional drilling of the mastoid process and anterior reflection of sigmoid sinus (SS), offers wider exposure of the CPA. [13][14][15][16][17][18][19][20][21][22][23] The objective of this article is to report on our operative approach and nuances of the surgical technique for removal of CPA meningiomas.…”

Section: Introductionmentioning

confidence: 99%

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Extended Retrosigmoid Approach for Cerebellopontine Angle Meningiomas: Operative Technique and Results—A Series of 28 Patients

et al. 2018

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The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cranial base approaches.

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“…29 Our experience, however, shows that these issues with the endoscope are diminished, if not resolved, through the use of the extended retrosigmoid approach previously described. 1 The broad surgical corridor provided by the extended retrosigmoid and other skull-base approaches used in this series easily allows 3 hands to remain in the field without combatting. In addition, the microscope remains in use simultaneously, and multiple monitors or "picture-in-picture" projection 41 allows for both surgeons to see both the microscopic and endoscopic views.…”

Section: Overcoming the Shortcomings Of The Endoscopementioning

confidence: 99%