We determined whether differences in smcv drainages patterns affected the perioperative management of petroclival meningioma. Petroclival meningiomas are based on or arising from the petro clival junction in upper twothirds of clivus, medial to the fifth. Founded in 1948, the aan now represents 30,000 members and is dedicated to promoting the highest quality patientcentered neurologic care and enhancing member career satisfaction. The nasoseptal flap was placed along the lateral wall of the nose throughout the procedure.
For example, a sphenoid wing meningioma may receive dominant supply from the ilt, the middle meningeal, or accessory meningeal arteries, depending on which vessel was the premorbid dominant supplier to the area of subsequent tumor origin. Hyperkinetic movement disorders of facial and neck muscles such as blepharospasm, hemifacial spasm, facial myokimia, and cervical dystonia have rarely been associated with unilateral brainstem or posterior fossa pathologies. Contrast mri in petroclival type case to show total resection by the rtta. There was no difference with respect to immediate postoperative. Drainage patterns of the superficial middle cerebral vein. Although the superficial middle cerebral vein smcv usually connects with the cavernous sinus, there are several anatomical variations. 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. Surgical management of petroclival tumors neupsy key.
Endoscopic endonasal approach for transclival resection of. In the rest of 6 patients, a partial removal of the meningioma was performed simpson grade iv. Nov 28, 2015 bakirkoy research and training hospital for neurology, neurosurgery and psychiatry, neurosurgery clinic, istanbulturkey. Retrosigmoid endoscopeassisted approach for petroclival. I was originally told that my tumor was inoperable due to the location petroclival. It is pyramidshaped and is situated at the base of the skull between the sphenoid and occipital bones. The video demonstrates the technical steps during surgery particularly highlighting the nuances during exposure and preservation of critical neurovascular structures. Petroclival meningioma is one of the most difficult tumors of the cranial base. In this 3dimensional surgical video, we describe the resection of a complex petroclival. To analyze the clinical features, surgical strategy and management outcomes of petroclival meningioma invading into cavernous sinus. A 54yearold woman with a large right petroclival meningioma figure 1 reported spontaneous spinning vertigo, oscillopsia, and rightsided clicking tinnitus lasting 530 seconds, recurring every 510 minutes.
For midline skull base meningiomas adjacent to the pituitary gland, a focused mri of the pituitary region, or orbits is often indicated to obtain better anatomical detail of a meningioma. True petroclival meningiomas dunn laboratory brigham and. Petroclival meningiomas are tumors that originate from the upper two third of th. Nov 21, 2018 i have a meningioma brain tumor what should i be doing. This mass has the classic appearance of a petroclival meningioma. Resection of a petroclival meningioma via the endoscopeassisted retrosigmoid approach. Keyhole craniotomies are increasingly being used for lesions of the skull base. Some patients have no symptoms at all, and others may have headaches, double vision, facial numbness, hearing loss, andor dizziness. Petroclival meningioma surgical neurology international. Show full abstract demonstrate 2 separate skull base approaches to resect a petroclival meningioma and discuss pitfalls and problems of management for challenging meningiomas. I have a meningioma brain tumor please help brain tumors. The typical presentation of a petroclival meningioma is that of an insidious onset. While slow growing, they can produce serious symptoms if left untreated, including headaches, hearing loss, facial problems and seizures. These data highlight the hazard associated with the presence of gross tumor bulk after surgery and suggest a value for more extensive resections that should be balanced against the additional potential morbidity.
Petrosal approach in management of petrous apex meningiomas and other petroclival tumors a free powerpoint ppt presentation displayed as a flash slide show on id. Van havenberg et al 22 investigated 21 patients with petroclival meningioma treated conservatively, with a minimum followup of 4 years. Petroclival meningiomas are lesions arising from the upper. The extent of resection is a powerful predictor of outcome for patients with atypical and malignant meningioma. Volumetric changes and clinical outcome for petroclival. Combined petrosal approach for resection of petroclival. Petroclival meningiomas are surgically challenging tumors due to the proximity to cranial nerves, major blood vessels, and the brainstem with considerably high. 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. It has been recommended that i have surgery to remove it before it interferes with my vision. The american academy of neurology the american academy of neurology aan is the worlds largest professional association of neurologists. Examination with video frenzel goggles revealed flurries of spontaneous rightbeating, horizontaltorsional irritative nystagmus, timelocked with vertigo video 1. These tumors displace the brain stem and the basilar artery to the opposite side. In this video, we aimed to demonstrate retrosigmoidtranstentorial resection of a 4.
Endoscopic endonasal transclival petroclival meningioma resection. This kind of neoplasia arises generally from the upper twothirds of the clivus, intimately associated with the brainstem, basilar artery, per. Pdf the surgical management of petroclival meningioma remains. One patient case 3 presented with a large petroclival meningioma extending out of the jugular foramen extracranially, and, in this case, a gtr of the intracranial component was achieved. A petroclival meningioma is a type of brain tumor located near the skull base, in an area known as the petroclival junction. Surgical excision of largetogiant petroclival meningiomas focusing. View or download all content the institution has subscribed to. Imaging demonstrated a petroclival meningioma located primarily lateral to the iac, and there was evidence of enlargement on serial imaging fig. I can offer you no advice, i am asking for information. This differentiates them from clivus meningiomas that arise close to the midline of the clivus 1 2. The following areas of research may include new options for patients. Petroclival meningioma arises in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve. Case report a 22 years man presented with right aural fullness and hearing impairment for one year.
Postoperative axial e and sagittal f mri show a complete tumor removal without. Resection of middle petroclival meningioma via combined anterior transpetrosal and retrosigmoid approaches at two separate stages. The lesion was totally removed througha transventricular approach. It is a tumour that starts in the meninges, the layers of tissue that surround and protect the brain and spinal cord. Petroclival meningiomas may be in the posterior fossa alone, or may span the middle and posterior cranial fossae. The cell of origin for the meningioma is the arachnoid cap cell. Treatment is usually supervised by an oncologist, working with a neurosurgeon to determine whether the tumor is operable and to develop an. In a patient with recurrent meningeal variant, for example, dominant supply will arise from the ophthalmic.
Endoscopic resection of a paraclinoid meningioma extending into the optic. Mayo clinic s worldrenowned meningioma teams include neuroradiologists, neuropathologists, neurosurgeons, medical and neurooncologists, radiation oncologists, neurologists, rehabilitation specialists and other professionals who work together to provide exactly the care you need. Neurosurgery video petroclival meningioma 1 youtube. Surgical management of petroclival meningiomas invading into. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3. Up next extended middle fossa approach for petroclival meningioma duration. These tumors are most often resected utilizing open transpetrosal approaches, but these operations, difficult even in the hands of dedicated skull base surgeons, are particularly challenging if the. Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. These tumors can be quite destructive to the clivus. The presigmoidal approach was selected to remove tumors. There is no charge to read or download any sni content, but registering for a free membership will provide you with additional special features. The superficial middle cerebral vein drained into the foramen ovale as the sphenobasal vein, and the sphenopetrosal vein draining into the superior petrosal sinus coursed on the middle skull base. Petroclival meningiomas diagnosis, treatment, and results.
Petroclival meningiomas neurosurgery oxford academic. The endoscopic endonasal transclival approach has been widely described for its use to resect clivus chordomas, but there have only been isolated reports of its use for petroclival meningiomas. Retrosigmoid approach for resection of petroclival meningioma. Autoplay when autoplay is enabled, a suggested video will automatically play next. Preoperative axial a, b, sagittal c and coronal d mri show a very large petroclival meningioma located mainly in the posterior fossa, invading into the whole clivus and the tentorium, extending toward the supratentorial region. Petroclival meningiomas are rare and account for less than 2% of all meningiomas. Retrosigmoidtranstentorial approach for petroclival. I too have a meningioma tumor located close to my optic nerve. Anterior transpetrosal approach for petroclival meningioma. Meningiomas are tumors of the meninges, the surface coverings of the central nervous system brain and spinal.
Petrosal approach in management of petrous apex meningiomas. Management of intracranial meningiomas using keyhole techniques. Most are benign and account for 33% of all newly diagnosed brain tumors. Among these, petroclival meningioma pcm can represent an astonishing example. The next day was devoted to meningiomas and contained 6 lectures, 5 luncheon seminars, 48 free presentations, one specialty seminar series on gammaknife radiosurgey and a video presentation.
Meningioma care at mayo clinic your mayo clinic care team. Resection of petroclival meningioma through retrosigmoid. Posterior petrosectomy in addition, the general resection techniques for removal of petroclival meningiomas. In the surgical therapy for central gyrus region meningioma with epilepsy as the primary symptom, the objective was to protect the brain functions, resect meningioma, and prevent seizure of epilepsy. This anatomic location is uniquely difficult to approach surgically because it is very closely surrounded by multiple neurovascular structures. Combined petrosal approach for resection of petroclival meningioma with endoscopic assistance. Luca nicosia 1, salvatore di pietro 1, michele catapano 1, gaia spadarella 1, lara sammut 2, christine cannataci 2, federico resta 3 and paolo reganati 3. The topics related to general considerations, clinical presentation, evaluation, and indications for surgery are discussed in the chapter titled petroclival meningioma. This 75yearold woman presented with gait difficulty and episodes of vague alterations of consciousness.
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. A 32 year old left handed woman complained about left sided. Extension to the medial tentorium, meckels cave, middle cranial fossa, parasellar area, petrosal and cavernous sinuses, and cranial nerve cn foramina may be seen. One day of the meeting was devoted to the venous system which contained 6 lectures, 5 luncheon seminars, 35 free presentations and a video presentation. Meningiomas ms are generally slowgrowing benign tumors attached to the dura mater and composed of neoplastic meningothelial arachnoidal cells.
To avoid any morbidity occurring by the surgery for petroclival meningioma, our treatment strategy is 1 the tumor should be left undetached in the case there is no csf space between tumor and the surrounding structures, to avoid new deficit, 2 the residual volume should be reduced to less than 20 ml, that is, small enough for radiosurgery. Diagnosis is confirmed by biopsy and pathologic analysis. Surgical treatment of petroclival meningioma with special. Combined petrosal approach for resection of petroclival meningioma. During the past 15 years, the field of cranial base surgery has been revolutionized by improvements in anesthetic and surgical techniques, as well as the use of multidisciplinary approaches. Fifteen cases with petroclival meningioma invading into cavernous sinus were retrospectively analyzed. Petroclival meningiomas are lesions arising from the upper two thirds of the clivus with dural attachment centered on the petroclival junction.
The retrosigmoid approach is suitable for treatment of selected petroclival meningioma if the main. Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from january 2012 to june 20. Petroclival meningioma mimicking the presentation of a transient. The results of gtr and ntr were thought to correspond to simpson grade resections of. The patient is a 51yearold woman with a petroclival meningioma extending into the cavernous sinus. The term petroclival meningioma was defined as meningiomas having their point of origin at the upper. During a year period 19912004, 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. Management of petroclival meningiomas by stereotactic. Petroclival meningiomas remain a formidable challenge for. He had undergone a ventilation tube insertion in the right ear 7 months ago at. Meningioma posterior fossa and petroclival center for. Nov 26, 2010 in this video, we show the first step retrosigmoid suprameatal approach and the second step frontotemporal approach for surgical removal of petroclival meningiomas with large supratentorial extension mp4 7,624 kb. Everytime i mention my condition to my family and friends they gave me a death sentence or change the topic so i need to know what i should be doing. Preservation of venous drainage in middle fossa during.
Retrosigmoid transtentorial resection of a petroclival. Curitiba, brazil the use of presigmoid approach to removea petroclival meningioma is showed in this video. Nov 12, 2017 petroclival pc meningiomas are difficulttotreat, deepseated skull base lesions arising from the petroclival synchondrosis with close proximity to vital neurovascular structures. They are located deep in the skull base, have an unpredictable growth pattern, and often envelope multiple cranial nerves as well as important venous and arterial structures. In this 3dimensional surgical video, we describe the resection of a complex petroclival meningioma operated through the standard retrosigmoid approach. Headace, mental changes and visual complaints are the most frequent. The neurosurgical atlas is committed to promoting neurosurgical education free of charge.
Hypofractionated radiosurgery for meningiomasa safer. Retractorless translabyrinthine approach for resection of a large acoustic neuroma. They are seated medial to the internal auditory meatus and posterior to the gasserian ganglion. Microsurgical treatment for central gyrus region meningioma. Resection of petroclival meningioma through retrosigmoid approachconcepts.
The goal of petroclival meningioma surgery is complete tumor removal, if possible, and to accomplish this without creating a functional decline of the patient. The slowgrowing pattern of petroclival meningiomas is usually associated with the onset of symptoms only after reaching a large size. 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. Figure 3 postoperative axial a and sagittal b mri with contrast from a patient who underwent a transclival resection of a petroclival meningioma. Retrosigmoid transtentorial resection of a petroclival meningioma. Petroclival meningiomas are based on or arising from the petroclival junction in upper twothirds of clivus, medial to the fifth. Meningioma posterior fossa and petroclival meningiomas are typically benign noncancerous, slowgrowing tumors that originate from arachnoidal cells, cells that make up a membrane that surrounds the brain and spinal cord.
Endoscopic resection of a paraclinoid meningioma extending into the optic canal. Endoscopic endonasal approach for transclival resection of a. Petroclival meningiomas arise from the upper two thirds of the clivus, at the petroclival junction and medial to the trigeminal nerve. Most studies report that the period of symptoms before diagnosis averages between 2. Nerve deficits after petroclival meningioma surgery.
Video 11, 2014 retrosigmoid approach for resection of petroclival meningioma anil nanda, m. The patient was placed in parkbench position and a leftsided suboccipital craniotomy was performed. Diagnosis is suspected by mri scan of the brain, with a study tailored to look at the skull base. The nuances of microsurgical and skull base technique are illustrated including drilling of the petrous bone, transecting the tentorium, resection of the tumor.
They tend to grow slowly, involve the cranial nerves, and compress the brainstem and the basilar artery, pushing them to the contralateral side. Anterior petrosectomy for upper petroclival meningioma. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6. Combined petrosal approach for resection of petroclival meningioma 23. 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. Petroclival meningiomas were originally considered largely unresectable. Petroclival meningiomas are one of the most complex skull base tumors because of their relation to. Right convexity craniotomy for resection of symptomatic atypical meningioma duration. You will read about the scientific research being done now to learn more about meningioma and how to treat it. In this operative video atlas manuscript, the authors demonstrate a stepbystep technique for microsurgical resection of a petroclival meningioma via the combined petrosal approach. With progression of the meningioma and further enlargement, intraventricular meningiomas can block csf flow causing csf to accumulate and intracranial pressure to rise hydrocephalus. The case was proven to be meningioma who 1 on histopathology. Vestibular paroxysmia presenting with irritative nystagmus. 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.
Minimally invasive resection of a cervical anterolateral. Doctors are working to learn more about meningioma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. Tumors extended into adjoining regions in 57% of the patients. Parasellar meningioma presenting by stroke and bilateral. Fukushimas microanatomy and dissection of the temporal bone. Participants twentytwo patients with petroclival meningioma originating from the upper twothirds of the clivus medial to the fifth cranial nerve.
Petroclival meningioma rightretrosigmoid approach video. They reported tumor growth in 76% of cases and clinical deterioration in 63%. Petroclival meningioma skull based tumor looking for. David petroclival meningiomas are among the most difficult cranial base lesions to treat. Presigmoid keyhole approach for petroclival meningiomas. Two step approach for surgical removal of petroclival. Until the 1970s, resection carried a 50% mortality rate, with very high rates of operative. 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. Extent of resection and overall survival for patients with. Case archives petroclival meningioma mht and ilt access. Such tumors are challenging to treat, as they are located deep inside the brain and may be difficult to access surgically. We report a case of unilateral cervicofacial dyskinesias due to an ipsilateral petroclival meningioma. Meningiomas are best diagnosed by an mri of the brain with gadolinium, or by a ct scan of the brain with contrast.
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