In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome glasgow outcome scale score 4 or 5 in 92% of patients, although the extent of grosstotal resection was only 28%. How to combine pdf files into one document lifewire. Their management has undergone paradigm shifts over the past few decades that span from radical resection to more tailored surgical decompression that offers. Some patients have no symptoms at all, and others may have headaches, double vision, facial numbness, hearing loss, andor dizziness. A meningioma is a type of tumour that grows from the protective canvaslike membrane called the meninges covering of the brain and spinal cord. Right a more centrally located petroclival meningioma with lateral extension up to the level of the internal acoustic canal would be better. May 27, 2014 the surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of these tumors. Petroclival meningiomas are challenging lesions to manage independently of the selected surgical approach and are unique tumors in the type of. Your story matters citation bi, wenya linda, michael zhang, winona w. Original article factors associated with improved karnofsky.
Posterior and anterior petrosectomies petroclival meningiomas are rare and account for less than 2% of all meningiomas. Petroclival meningioma, retrosigmoid, skull base, tentorium. The treatment is tailored to the size and extent of disease with consideration given to the health of the patient. It goes from the dorsum sellae to the foramen jugularis. Petroclival meningiomas, by definition, are tumors that originate in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve. Aug 23, 2012 petroclival meningioma decision making dr. This differentiates them from clival meningiomas that arise close to the midline of the clivus. Petroclival meningioma is a deep tumor in the posterior fossa lying in front of the brain stem which can be injured either directly or indirectly through vascular injury causing several complications. The topics related to general considerations, clinical presentation, evaluation, and indications for surgery are discussed in the chapter titled petroclival meningioma. The goal of petroclival meningioma surgery is complete tumor removal, if possible, and to accomplish this without creating a functional decline of the patient. Jun 01, 2016 large petroclival meningioma with extension into supratentorial space. A new scoring system, the petroclival meningioma impairment scale pcmis, was created for quantitative assessment of 8 categories of neurological functions, with scores assigned in each category according to the level of disability and its impact on the patient.
Full text full text is available as a scanned copy of the original print version. Recent surgical results and outcomes mugurel radoi1, florin stefanescu 1, ram vakilnejad 2, lidia gheorghitescu 2, daniela rosu 2 1umf carol davila bucharest. Case discussion meningiomas are the most common extraaxial tumors of the central nervous system. Fifty patients underwent surgical treatment for petroclival meningiomas. Rearrange individual pages or entire files in the desired order. The authors report on a series of patients with large and giant skull base meningiomas who were treated with the goal of radical removal. Pdf the surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures. However, it is clear that the development of microsurgical techniques and skull base approaches. Tumor progression following petroclival meningioma subtotal. Preoperative nf and postoperative lower row mr images demonstrating a large petroclival meningioma extending below the iam in a patient with intact hearing, prompting a posterior petrosal approach for resection. Petroclival meningiomas still pose a formidable challenge to neurosurgeons. Treatment usually involves a combination of surgery and radiation treatment.
Soda pdf merge tool allows you to combine two or more documents into a single pdf file for free. Retrosigmoid transtentorial resection of a petroclival meningioma. Petroclival meningiomas resected via a combined transpetrosal. We surveyed the relevant literature available on intracranial meningioma surgery and subsequent outcomes 38 papers, making note of which, if. In the rest of 6 patients, a partial removal of the meningioma was performed simpson grade iv. Petroclival pc meningiomas are difficulttotreat, deepseated skull base lesions arising from the petroclival synchondrosis with close proximity to vital neurovascular structures.
The article underscores the importance of neurologic and neuroradiologic examination in diagnosing and managing patients with facial pain conditions. However, in many patients, tumor has to be left behind in the cs, around cranial nerves or the arteries, or when invading the brainstem pial plate. Petroclival meningioma skull based tumor looking for some. In the present study, no petroclival meningioma cases in which the smcv connected with the cavernous sinus manifested any complications of pre, intra, or postoperative management of surgical treatment. I was just diagnosed with a large petroclival meningioma skull based tumor and i am seeking any advise or guidance you may have to offer. Therapymeningioma factmng, a webbased tumor sitespeci. Middle cranial fossa surgery tumor removal always dissect tumor medial to lateral prevents disruption of fragile auditory nerve entering cribrosa use fine micro instruments such as 1 2.
Reports in the literature of surgical outcomes in petroclival meningiomas. Large petroclival meningioma with extension into supratentorial space. This report subclassifies petroclival meningiomas based on their origin determined by using radiological and intraoperative findings. Retrosigmoid approach for resection of petroclival meningioma. Get a printable copy pdf file of the complete article 2. These tumours are most commonly found in middleaged or older people, and in particular in women.
Meningiomas 36 29 iwai y, yamanaka k, yasui t, komiyama m, nishikawa m, nakajima h, kishi h. Total removal of tumor of right retrosigmoid approach using neurophysiologic monitoring. Petroclival meningioma skull based tumor looking for. Petroclival meningiomas may be in the posterior fossa alone, or may span the middle and posterior cranial fossae. This case, presented by hallopeau, 8 may represent the first report of a petroclival meningioma in the literature. An update on surgical approaches, decision making, and treatment results article pdf available in neurosurgical focus 356. We consider clival and petroclival meningiomas as one entity, because the operative decisionmaking process in treating these two lesions is virtually identical. Extended middle fossa approach with anterior petrosectomy.
Further improvement in the management of petroclival meningiomas has been achieved with microsurgery combined with cranial base approaches 1, 2, 1620, 23, 24, 29, 3238, 41. All uploads and downloads are deemed secure and files are permanently deleted from the smallpdf servers within an hour. From what i have been able to research, this is a rare tumor that is located in a very bad location as it is right were all of the cranial nerves and arteries are located at the base of the skull. Outcomes of endonasal and lateral approaches to petroclival. In this operative video, the author demonstrates the extended middle fossa approach with anterior petrosectomy to resect an upper petroclival meningioma extending into. Petroclival meningioma, recurrenceprogression, surgical treatment, prognostic factors, quality of life, karnofsky performance score introduction petroclival meningiomas account for approximately 310% of posterior fossa meningiomas 1. Petroclival meningioma arises in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve. Petroclival meningioma presenting with pathological. Group apatients cases have been operated on using mostly either a subtemporal trans tentorial or a retrosigmoid approach. Delayed malignant transformation of petroclival meningioma to chondrosarcoma after stereotactic radiosurgery. Petroclival meningiomas are surgically challenging tumors due to the proximity to cranial nerves, major blood vessels, and the brainstem with considerably high. The prognosis for patients with atypical and malignant meningioma is guarded. This video describes the classic retrosigmoid approach for the resection of petroclival lesions. The trochlear nerve is often injured due to its size and fragility.
Petroclival meningiomas neurosurgery oxford academic. Factors associated with improved karnofsky performance status. Pdf surgical removal of small petroclival meningiomas. It has been successfully applied with acceptable morbidity and mortality rates, mainly for spheno petroclival meningiomas. One study has investigated postoperative growth rates following subtotal resection of petroclival meningiomas. Cranial nerves are at significant risk during the removal of petroclival meningiomas. Soda pdf merge tool allows you to combine two or more documents into a single pdf file. Petroclival meningiomas are rare and account for less than 2% of all meningiomas. Petroclival lesions displace the brainstem posteriorly. True petroclival meningiomas 41 medial to the fifth cranial nerve cn v and consider these true petroclival meningiomas for their distinct clinical and outcome considerations. Before you combine the files into one pdf file, use merge pdf to draganddrop pages to reorder or to delete them as you like. Meningiomas of the clivus have been traditionally considered an almost prohibitive surgical challenge 4,5,7,11,14. The postoperative images demonstrate complete resection via the posterior approach.
Presigmoid sinus approach to petroclival meningiomas ncbi nih. Pdf endoscopic transsphenoidal surgery for petroclival. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome glasgow otcome scale score 4 or 5 in 92% of patients, although the extent of grosstotal resection was only 28%. Petroclival meningioma presenting with pathological laughter. Pdf merge combinejoin pdf files online for free soda pdf. We provide a modified surgical technique called retrosigmoidtranstentorial approach rtta to solve these problems. As mentioned, perforators from the basilar artery can be quite difficult to identify and separate from the tumor, particularly when a large petroclival meningioma encases the basilar artery. Surgical management of petroclival meningiomas clinical gate. 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. Left petroclival meningioma with wide dural base across the petrous ridge with extension to the cerebellopontine angle and invasion of the internal acoustic canal would be an approached via rsa. In the past, petroclival meningiomas were described only in postmortem studies. Petroclival meningioma, surgical approach, skull base surgery, results of microsurgical management. These patients require serial mri scans for their entire life.
The authors surgical removal of small petroclival meningiomas 439 responses is quite clear, and i tend to agree with them. In addition, the general resection techniques for removal of petroclival meningiomas. The advent of microsurgical techniques has allowed some master surgeons to report very encouraging results of. These tumors displace the brain stem and the basilar artery to the opposite side. Get a printable copy pdf file of the complete article 1. Posterior fossa meningioma surgical experiences sciencedirect. During a year period 19912004, 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. Additionally, the rarity of petroclival meningiomas, variations in treatment philosophies, and heterogeneity in the types of data reported add to the convoluted picture. It can be classified according to the location in the posterior fossa into cerebellopontine angle, clival, petroclival, convexity, tentorial and foramen magnum. Neurosurgical department of the national institute of neurology and neurovascular diseases bucharest. Meningioma is a common tumor that represents about 30% of all intracranial tumors. Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach xinru xiao liwei zhang zhen wu junting zhang guijun jia jie tang guolu meng the authors describe a modified anterior transpetrous approach atpa for the surgical resection of 21 cases of petroclival meningiomas pcms. True petroclival meningiomas dunn laboratory brigham and.
This study investigated the association between gross total resection gtr and allcause mortality in patients with atypical and malignant meningioma. Nerve deficits after petroclival meningioma surgery inspire. Extent of resection and overall survival for patients with. Ninetyone patients with petroclival meningioma underwent surgery via the anterior transpetrosal approach. There was no difference with respect to immediate postoperative. The typical presentation of a petroclival meningioma is that of an insidious onset.
Methods thirtyone cases of petroclival meningioma have been operated on during a 4year period using two different philosophies as far as the approach. These tumors arise along the upper twothirds of the clivus, superior to the jugular foramen and medial to the cranial nerves foramina at the petroclival junction. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. Petroclival meningiomas are vaguely defined as tumours arising from the anteromedial zone to the internal auditory meatus. Methods between january 1990 and december 2009, 60 consecutive patients with benign who grade i petroclival meningiomas underwent microsurgical resection via a combined transpetrosal approach at osaka city university. They also represent one of the most controversial entities with regard to approach selec.
The tumor size was large in 79% of the patients, with a mean tumor diameter of 3. Petroclival meningioma had all postoperative complication items and all the postoperative mortality cases. The large and giant skull base meningiomas are challenging lesions, and the involvement of crucial neurovascular structures needs the surgical removal as the primordial treatment. The petroclival region is a surgical space circumscribed anteriorly by the clivus, laterally by the petrous apex, medially by the brainstem and posteriorly by the internal acoustic canal. The surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of. Petroclival meningiomas are difficult to treat due to their intimate location with critical structures, and complete microsurgical resection is often associated with significant morbidity. Petroclival meningioma, recurrenceprogression, surgical treatment. Left petroclival meningioma, with intraosseous extension into left petrous apex. Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base. Petroclival meningiomas diagnosis, treatment, and results. Most studies report that the period of symptoms before diagnosis averages between 2.
Petroclival meningiomas are slowgrowing tumors that usually produce clinical symptoms after reaching large size. Diagnostic, prognostic, and therapeutic applications the harvard community has made this article openly available. These tumors are deep in the base of the skull and arise medial to the fifth cranial nerve. Drainage patterns of the superficial middle cerebral vein. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6. A meningioma is a tumor that grows from the dura membrane blue covering the brain and spinal cord. Petroclival meningiomas were originally considered largely unresectable. It seems doubtful whether radical surgical removal should always be the primary goal in those lesions as advocated until very recently. Jun 18, 2016 petroclival meningiomas pcms are technically challenging lesions.