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Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia

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Abstract

Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm3, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.

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Acknowledgments

The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations.

Funding

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the government of Korea (No. 2020R1A2C200848011) and the Faculty Research Grant of Yonsei University College of Medicine (6-2019-0105).

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Author notes

  1. Won Seok Chang and Chang-Ki Hong contributed equally to this article and share their senior authorship.

Authors and Affiliations

  1. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Hun Ho Park, Woo Hyun Kim, Kyu-Sung Lee & Chang-Ki Hong

  2. Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hyun-Ho Jung, Jong Hee Chang & Won Seok Chang

  3. Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea

    Hyun-Ho Jung, Jong Hee Chang & Won Seok Chang

  4. Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea

    Hyun-Ho Jung, Jong Hee Chang & Won Seok Chang

  5. Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea

    Hyun-Ho Jung, Jong Hee Chang & Won Seok Chang

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  1. Hun Ho Park
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Correspondence to Won Seok Chang or Chang-Ki Hong.

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The study was approved by the institutional review board and conducted in accordance with the ethical guidelines of the Declaration of Helsinki.

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Park, H.H., Kim, W.H., Jung, HH. et al. Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia. Neurosurg Rev 43, 1631–1640 (2020). https://doi.org/10.1007/s10143-020-01346-8

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  • DOI: https://doi.org/10.1007/s10143-020-01346-8

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