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J Neurol Surg B Skull Base 2018; 79(04): 367-378
DOI: 10.1055/s-0037-1608654
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Petroclival Meningiomas: Factors Determining the Choice of Approach

Gustavo Rassier Isolan
1   Graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS); Neurotology and Acoustic Neuroma Center (CNNA); Clínica Lavinsky; Hospital Moinhos de Vento – Porto Alegre, Rio Grande do Sul, Brazil
2   The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
,
Sâmia Yasin Wayhs
3   Graduate Program in Medicine: Surgical Sciences, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
,
Guilherme Alves Lepski
4   Department of Neurology, Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
5   Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
,
Leandro Infantini Dini
2   The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
,
Joel Lavinsky
6   Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
7   CNNA; Clínica Lavinsky, Porto Alegre, Rio Grande do Sul, Brazil
› Author Affiliations
Further Information

Publication History

22 June 2017

30 September 2017

Publication Date:
11 December 2017 (online)

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Abstract

Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach.

Design Retrospective review.

Setting The study was conducted in a university hospital in southern Brazil.

Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve.

Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence.

Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6–75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery.

Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.

Keywords

brain tumor - clivus - meningioma - petroclival - skull base
 

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