Petroclival and foramen magnum meningiomas: Surgical approaches and pitfalls
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Abstract
The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial base surgery. However, these tumors are still among the most difficult cranial base lesions to treat. In this report, we discuss the classification, presenting symptoms, preoperative investigation, treatment indications, operative approaches and technique, postoperative complications and care, and results of surgery of petroclival and foramen magnum meningiomas. Careful analysis of tumor- and patient-related factors has helped us to predict which features can lead to postoperative problems in patients allowing surgeons to appropriately modify their behavior. The application of cranial base tecniques - combined with new knowledge about the limitations of microsurgical resection - can greatly reduce postoperative morbidity in these patients.
Key words
meningiomas petroclival posterior fossa surgeryPreview
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References
- 1.Long DM: Surgical approaches to tumors of the skull base: An overview. In: Wilkins RH, Rengachary SS (eds) Neurosurgery Update I: Diagnosis, Operative Technique, and Neuro-oncology. McGraw-Hill, New York, 1990, pp 226–276Google Scholar
- 2.Campbell E, Whitfield RD: Posterior fossa meningiomas. J Neurosurg 5:131–153,1948Google Scholar
- 3.Cherington M, Schneck SA: Clivus meningiomas. Neurology 16: 86–92,1966Google Scholar
- 4.Russell JR, Bucy PC: Meningiomas of the posterior fossa. Surg Gynecol Obstet 96:183–192,1953Google Scholar
- 5.Cushing HW, Eisenhardt L: Meningiomas. Their Classification, Regional Behaviour, Life History and Surgical End Results. Charles C. Thomas, Springfield, IL, 1938, pp 3–387Google Scholar
- 6.Yasargil MG, Mortara RW, Curcic M: Meningiomas of the basal posterior cranial fossa. In: Krayenbuhl H (ed) Advances and Technical Standards in Neurosurgery, Volume 7. Springer-Verlag, Wien,1980, pp 1–115Google Scholar
- 7.Castellano F, Ruggiero G: Meningiomas of the posterior fossa. Acta Radiol (suppl) 104:1–157,1953Google Scholar
- 8.Olivecrona H: The surgical treatment of intracranial tumors. In: Olivecrona H, Tennis W (eds) Handbuch der Neurochirurgic. Springer-Verlag, Berlin, 1967, pp 1–301Google Scholar
- 9.Briccolo AP, Turazzi S, Talacchi A, Cristofori L: Microsurgical removal of petroclival meningiomas: A report of 33 patients. Neurosurgery 31: 813–828,1992Google Scholar
- 10.Sekhar LN, Swamy NKS, Jaiswal U, Rubinstein E, Hirsch Jr. WE, Wright DC: Surgical excision of meningiomas involving the clivus: Preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81: 860–868,1994Google Scholar
- 11.See Reference 6Google Scholar
- 12.Al-Mefty O, Fox JL, Smith RR: Petrosal approach for petroclival meningiomas. Neurosurgery 22: 510–517,1988Google Scholar
- 13.Sekhar LN, Jannetta PJ, Burkhart L, Janosky J: Meningiomas involving the clivus: A six-year experience with 41 patients. Neurosurgery 27: 764–781,1990Google Scholar
- 14.Mayberg MR, Symon L: Meningiomas of the clivus and apical petrous bone. Report of 35 cases. J Neurosurg 65:160–167, 1986Google Scholar
- 15.Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A: Surgery of petroclival meningiomas: Report of 24 cases. Neurosurgery 24:12–17,1989Google Scholar
- 16.Nishimura S, Hakuba A, Jang B, Inoue Y: Clivus and apicopetroclivus meningiomas: Report of 24 cases. Neurol Med Chir 29:1004–1011,1989Google Scholar
- 17.Spetzler RF, Daspit CP, Pappas CTE: The combined supraand infratentorial approach for lesions of the petrous and clival regions: Experience with 46 cases. J Neurosurg 76: 588–599,1992Google Scholar
- 18.See Reference 9Google Scholar
- 19.Al-Mefty O, Smith RR: Clival and petroclival meningiomas. In: Al-Mefty O (ed) Meningiomas. Raven, New York, 1991, pp 517–537Google Scholar
- 20.Sekhar LN, Javed T, Jannetta PJ: Petroclival meningiomas. In: Sekhar LN, Janecka IP (eds) Surgery of Cranial Base Tumors. Raven Press, New York, 1993, pp 605–659Google Scholar
- 21.Hakuba A, Nishimua S, Jang BJ: A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 30:108–116,1988Google Scholar
- 22.See Reference 10Google Scholar