Journal article
Feasibility and Limitations of the Retrosigmoid and Presigmoid Approaches Combined With the Anterior Petrosal Approach to Meningiomas in the Petroclival Area
Neurosurgery quarterly, Vol.23(1), pp.7-12
02/01/2013
DOI: 10.1097/WNQ.0b013e31825a6bdd
Abstract
Meningiomas located in the petroclival junction are difficult lesions to manage. Usually, they are diagnosed when they become large-sized symptomatic lesions and extend to adjacent areas. The curative treatment is surgical resection, but the intricate and eloquent neurovascular anatomy of the petroclival complex and adjacent areas challenges the surgeon while considering total tumor resection against the acceptable morbidity and mortality. The authors report 10 case series of tumors arising from or extending to the petroclival junction; they included 10 meningiomas: 4 petroclival, 3 sphenopetroclival, 2 tentorial at the petroclival area, and 1 anterior petrosal operated from 2007 to 2011 in the Hiroshima University Hospital. They were subjected to the combined approaches: anterior petrosal, presigmoid, and retrosigmoid. The translabyrinth approach was added in 2 cases where hearing was previously lost. Gross total resection was possible in 6 cases. The mortality rate was 0. The main complications were postoperative cerebrospinal fluid leak in 1 case, permanent cranial nerve palsy in 3 cases, and venous congestion in 1 case. The main limiting factors for good outcome are the tumor size, wide attachment, hard consistency, bleeding, and preoperative clinical status. Involvement of the basilar artery and perforators, attachment to the brainstem, and avoidance of venous damage are also important points to be considered. As a rule, the anterior petrosal approach yields direct access to the tumor attachment, permitting early devascularization, and direct approach to medial cranial fossa base content. The retrosigmoid is necessary when the tumor is very large and has extended below the internal acoustic meatus. The presigmoid access is useful for cases where the tumors extend to the medial cranial fossa; it reduces the required amount of retraction of the temporal lobe, as it permits the surgeon to change the angle of attack from the lateral to the inferior range.
Details
- Title: Subtitle
- Feasibility and Limitations of the Retrosigmoid and Presigmoid Approaches Combined With the Anterior Petrosal Approach to Meningiomas in the Petroclival Area
- Creators
- Kuniki Eguchi - Hiroshima Univ, Dept Neurosurg, Hiroshima, JapanAdriana Tahara - Hiroshima Univ, Dept Neurosurg, Hiroshima, JapanSatoshi Yamaguchi - Hiroshima Univ, Dept Neurosurg, Hiroshima, JapanToshinori Matsushige - Hiroshima Univ, Dept Neurosurg, Hiroshima, JapanTakafumi Mitsuhara - Hiroshima Univ, Dept Neurosurg, Hiroshima, JapanAlexandros Theodoros Panagopoulos - Div Neurosurg, Santa Casa De Sao Paulo, BrazilPaulo Henrique Pires Aguiar - Univ Sao Paulo, Dept Neurol, Sao Paulo, BrazilKaoru Kurisu - Hiroshima Univ, Dept Neurosurg, Hiroshima, Japan
- Resource Type
- Journal article
- Publication Details
- Neurosurgery quarterly, Vol.23(1), pp.7-12
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/WNQ.0b013e31825a6bdd
- ISSN
- 1050-6438
- eISSN
- 1534-4916
- Number of pages
- 6
- Language
- English
- Date published
- 02/01/2013
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984303913002771
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