Download PDF
J Neurol Surg B Skull Base 2012; 73(01): 001-010
DOI: 10.1055/s-0032-1304835
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posterior Cranial Fossa Meningiomas[*]

Vijayakumar Javalkar
1   Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
,
Anirban Deep Banerjee
1   Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
,
Anil Nanda
1   Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
› Author Affiliations
Further Information

Publication History

22 December 2010

13 July 2011

Publication Date:
24 February 2012 (online)

    Permissions and Reprints

See also:

Posterior Cranial Fossa MeningiomasSkull Base 2011; 21(S 02): e12-e12
DOI: 10.1055/s-0031-1287684

Abstract

This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.2%). Headache was the most common symptom. Retrosigmoid approach was the commonest surgical procedure (23.4%). The incidence of cranial nerve related complications was 28%. Postoperatively facial nerve weakness was observed in 11%. The incidence of cerebrospinal fluid leak was 4.6%. Gross total resection was achieved in 37 patients (58%). Sixteen patients (25%) with residual tumors underwent Gamma knife radiosurgery. Recurrence or tumor progression was observed in 12 patients (18.7%). Operative mortality was 3.1%. At their last follow-up, 93% of the cases achieved Glasgow Outcome Scale scores 4 or 5. Total excision is the ideal goal which can be achieved with meningiomas located in certain location, such as lateral convexity, but for other posterior fossa meningiomas the close proximity of critical structures is a major obstacle in achieving this goal. In practicality, a balance between good functional outcome and extent of resection is important for posterior cranial fossa meningiomas in proximity to critical structures.

Keywords

posterior fossa - skull base - meningiomas

* This article was originally Published online in Skull Base on September 27, 2011 (DOI:10.1055/s-0031-1287684)


 

  • References

  • 1 Campbell E, Whitfield RD. Posterior fossa meningiomas. J Neurosurg 1948; 5 (2) 131-153
    CrossrefPubMedGoogle Scholar
  • 2 Castellano F, Ruggiero G. Meningiomas of the posterior fossa. Acta Radiol Suppl 1953; 104: 1-177
    PubMedGoogle Scholar
  • 3 Sekhar LN, Wright DC, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neurooncol 1996; 29 (3) 249-259
    CrossrefPubMedGoogle Scholar
  • 4 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988; 22 (3) 510-517
    CrossrefPubMedGoogle Scholar
  • 5 Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 1989; 24 (1) 12-17
    CrossrefPubMedGoogle Scholar
  • 6 Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 1992; 76 (4) 588-599
    CrossrefPubMedGoogle Scholar
  • 7 Roberti F, Sekhar LN, Kalavakonda C, Wright DC. Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 2001; 56 (1) 8-20 , discussion 20–21
    CrossrefPubMedGoogle Scholar
  • 8 Cudlip SA, Wilkins PR, Johnston FG, Moore AJ, Marsh HT, Bell BA. Posterior fossa meningiomas: surgical experience in 52 cases. Acta Neurochir (Wien) 1998; 140 (10) 1007-1012
    CrossrefPubMedGoogle Scholar
  • 9 Goel A, Muzumdar D. Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. Surg Neurol 2004; 62 (4) 332-338 , discussion 338–340
    CrossrefPubMedGoogle Scholar
  • 10 Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 2005; 56 (3) 546-559 , discussion 546–559
    CrossrefPubMedGoogle Scholar
  • 11 Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PH. Surgical removal of small petroclival meningiomas. Acta Neurochir (Wien) 2008; 150 (5) 431-438 , discussion 438–439
    CrossrefPubMedGoogle Scholar
  • 12 Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 1986; 64 (4) 559-562
    CrossrefPubMedGoogle Scholar
  • 13 Wen HT, Rhoton Jr AL, Katsuta T, de Oliveira E. Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 1997; 87 (4) 555-585
    CrossrefPubMedGoogle Scholar
  • 14 Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A. Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg 2002; 96 (2) 302-309
    CrossrefPubMedGoogle Scholar
  • 15 Yasargil MG. Meningiomas. In: Yasargil MG, ed. Microneurosurgery of CNS Tumors. New York: Thieme Verlag; 1996: 134-185
    Google Scholar
  • 16 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir (Wien) 1992; 118 (1–2) 27-32
    CrossrefPubMedGoogle Scholar
  • 17 Shen T, Friedman RA, Brackmann DE , et al. The evolution of surgical approaches for posterior fossa meningiomas. Otol Neurotol 2004; 25 (3) 394-397
    CrossrefPubMedGoogle Scholar
  • 18 Lobato RD, Gonzaáez P, Alday R , et al. Meningiomas of the basal posterior fossa. Surgical experience in 80 cases. Neurocirugia (Astur) 2004; 15 (6) 525-542
    PubMedGoogle Scholar
  • 19 Saleh EA, Taibah AK, Achilli V, Aristegui M, Mazzoni A, Sanna M. Posterior fossa meningioma: surgical strategy. Skull Base Surg 1994; 4 (4) 202-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Adachi K, Kawase T, Yoshida K, Yazaki T, Onozuka S. ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article. J Neurosurg 2009; 111 (5) 1053-1061
    CrossrefPubMedGoogle Scholar
  • 21 Sekhar LN, Swamy NK, Jaiswal V, 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 1994; 81 (6) 860-868
    CrossrefPubMedGoogle Scholar
  • 22 Lefkowitz MA, Hinton DR, Weiss MH, Giannotta SL, Couldwell WT. Prognostic variables in surgery for skull base meningiomas. Neurosurg Focus 1997; 2 (4) e2
    PubMedGoogle Scholar
  • 23 Kabil MS, Shahinian HK. Application of the supraorbital endoscopic approach to tumors of the anterior cranial base. J Craniofac Surg 2005; 16 (6) 1070-1074 , discussion 1075
    CrossrefPubMedGoogle Scholar
  • 24 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25 (6) E8
    PubMedGoogle Scholar
  • 25 Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 2004; 55 (3) 539-547 , discussion 547–550
    CrossrefPubMedGoogle Scholar
  • 26 Dusick JR, Esposito F, Kelly DF , et al. The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 2005; 102 (5) 832-841
    CrossrefPubMedGoogle Scholar
  • 27 Jho HD. Endoscopic transsphenoidal surgery. J Neurooncol 2001; 54 (2) 187-195
    Google Scholar
  • 28 Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106 (3) 400-406
    CrossrefPubMedGoogle Scholar
  • 29 Gardner PA, Kassam AB, Thomas A , et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63 (1) 36-52 , discussion 52–54
    CrossrefPubMedGoogle Scholar
  • 30 Solares CA, Grindler D, Luong A , et al. Endoscopic management of sphenoclival neoplasms: anatomical correlates and patient outcomes. Otolaryngol Head Neck Surg 2010; 142 (3) 315-321
    CrossrefPubMedGoogle Scholar
  • 31 Abuzayed B, Tanriover N, Gazioglu N, Akar Z. Extended endoscopic endonasal approach to the clival region. J Craniofac Surg 2010; 21 (1) 245-251
    CrossrefPubMedGoogle Scholar
  • 32 de Notaris M, Cavallo LM, Prats-Galino A , et al. Endoscopic endonasal transclival approach and retrosigmoid approach to the clival and petroclival regions. Neurosurgery 2009; 65 (6, Suppl) 42-50 , discussion 50–52
    PubMedGoogle Scholar
  • 33 Cavallo LM, Cappabianca P, Messina A , et al. The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study. Childs Nerv Syst 2007; 23 (6) 665-671
    CrossrefPubMedGoogle Scholar
  • 34 Goravalingappa R, Han JC, Mangiardi J, Levenson M. Endoscopic/microscopic approach to sphenopetroclival complex: an anatomical study. Skull Base Surg 1999; 9 (1) 33-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Cavallo LM, Messina A, Gardner P , et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 2005; 19 (1) E5
    PubMedGoogle Scholar
  • 36 Mortini P, Roberti F, Kalavakonda C, Nadel A, Sekhar LN. Endoscopic and microscopic extended subfrontal approach to the clivus: a comparative anatomical study. Skull Base 2003; 13 (3) 139-147
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 3—The clivus and posterior fossa. Minim Invasive Neurosurg 2004; 47 (1) 16-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 de Divitiis O, Conti A, Angileri FF, Cardali S, La Torre D, Tschabitscher M. Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study. Neurosurgery 2004; 54 (1) 125-130 , discussion 130
    CrossrefPubMedGoogle Scholar
  • 39 Morera VA, Fernandez-Miranda JC, Prevedello DM , et al. “Far-medial” expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches. Neurosurgery 2010; 66 (6, Suppl Operative) 211-219 , discussion 219–220
    PubMedGoogle Scholar
  • 40 Alfieri A, Jho HD, Tschabitscher M. Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study. Acta Neurochir (Wien) 2002; 144 (3) 219-225 , discussion 225
    CrossrefPubMedGoogle Scholar
  • 41 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19 (1) E6
    PubMedGoogle Scholar
  • 42 Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB. Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 2009; 119 (1) 19-25
    CrossrefPubMedGoogle Scholar
  • 43 Kassam AB, Prevedello DM, Thomas A , et al. Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 2008; 62 (3, Suppl 1) 57-72 , discussion 72–74
    CrossrefPubMedGoogle Scholar
  • 44 Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 2010; 67 (3, Suppl Operative) ons150-ons158 , discussion ons158
    CrossrefPubMedGoogle Scholar
  • 45 Alexander H, Robinson S, Wickremesekera A, Wormald PJ. Endoscopic transsphenoidal resection of a mid-clival meningioma. J Clin Neurosci 2010; 17 (3) 374-376
    CrossrefPubMedGoogle Scholar
  • 46 Solares CA, Fakhri S, Batra PS, Lee J, Lanza DC. Transnasal endoscopic resection of lesions of the clivus: a preliminary report. Laryngoscope 2005; 115 (11) 1917-1922
    CrossrefPubMedGoogle Scholar
  • 47 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1, Suppl 1) ONS44-ONS52 , discussion ONS52–ONS53
    CrossrefPubMedGoogle Scholar
  • 48 Lund VJ, Stammberger H, Nicolai P , et al. European Rhinologic Society Advisory Board on Endoscopic Techniques in the Management of Nose, Paranasal Sinus and Skull Base Tumours. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22 (22) 1-143
    PubMedGoogle Scholar
  • 49 Yingling CD, Gardi JN. Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992. Neurosurg Clin N Am 2008; 19 (2) 289-315 , vii
    CrossrefPubMedGoogle Scholar
  • 50 Adeolu AA, Sutherland GR. Intraoperative magnetic resonance imaging and meningioma surgery. West Afr J Med 2006; 25 (3) 174-178
    PubMedGoogle Scholar