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Surgical outcomes of anterior cerebellopontine angle meningiomas using the anterior transpetrosal approach compared with the lateral suboccipital approach

  • Original Article - Neurosurgery general
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Abstract

Background

Anterior transpetrosal approach (ATPA) and lateral suboccipital approach (LSO) are the major surgical approaches for cerebellopontine angle (CPA) meningiomas. Particularly, anterior CPA meningiomas are challenging lesions to be treated surgically. To date, only a few studies have directly compared the outcomes of both approaches focusing on the anterior CPA meningiomas.

Methods

For the comparative analysis, anterior CPA meningiomas that were eligible for both APTA and LSO were collected in our hospital from April 2005 to March 2017. Anterior CPA meningiomas targeted for this study were defined as follows: (1) without cavernous sinus, clivus, and middle cranial fossa extension, (2) the posterior edge is 1 cm behind the posterior wall of the internal auditory canal, and (3) the inferior edge is above the jugular tuberculum. Based on these criteria, the operative outcomes of 17 patients and 13 patients who were operated via ATPA and LSO were evaluated.

Results

The complication rate of the LSO group was significantly higher than that of the ATPA group (30.7% vs. 0%, p = 0.033). The removal rate did not differ between the ATPA and LSO groups (97.35% vs. 99.23%, p = 0.12). The operative time was significantly shorter in the LSO group than in the ATPA group (304.3 min vs. 405.8 min, p = 0.036).

Conclusions

Although the LSO is more widely used for CPA meningiomas, ATPA is also considered for these anterior CPA meningiomas.

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References

  1. Abdel AKM, Sanan A, van Loveren HR, Tew JM Jr, Keller JT, Pensak ML (2000) Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery 47:139–150

    Google Scholar 

  2. Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22:510–517

    Article  CAS  PubMed  Google Scholar 

  3. Alonso SA, Polo LR, Labatut PT, Fogué CL (2010) Meningioma of the internal auditory canal: a rare entity. Acta Otorrinolaringol Esp 61:387–388

    Article  Google Scholar 

  4. Aziz KM, Tew JM Jr, Chicoine MR (1999) The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery 44:1225–1236

    CAS  PubMed  Google Scholar 

  5. Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, Spetzler RF (2007) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 61:202–209

    PubMed  Google Scholar 

  6. Baroncini M, Thines L, Reyns N, Schapira S, Vincent C, Lejeune JP (2011) Retrosigmoid approach for meningiomas of the cerebellopontine angle: results of surgery and place of additional treatments. Acta Neurochir 153:1931–1940

    Article  PubMed  Google Scholar 

  7. Beniwal M, Bhat DI, Rao N, Bhagavatula ID, Somanna S (2015) Surgical management of petroclival meningiomas: factors affecting early post-operative outcome. Br J Neurosurg 29:559–564

    Article  PubMed  Google Scholar 

  8. Bernard F, Troude L, Isnard S, Lemée JM, Terrier LM, François P, Velut S, Gay E, Fournier HD, Roche PH (2019) Long term surgical results of 154 petroclival meningiomas: a retrospective multicenter study. Neurochirurgie 65:55–62

    Article  CAS  PubMed  Google Scholar 

  9. Bricolo AP, Turazzi S, Talacchi A, Cristofori L (1992) Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31:813–828

    Article  CAS  PubMed  Google Scholar 

  10. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV (2018) An overview of meningiomas. Future Oncol 14:2161–2177

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Campbell E, Whitfield RD (1948) Posterior fossa meningiomas. J Neurosurg 5:131–153

    Article  CAS  PubMed  Google Scholar 

  12. Chang SW, Wu A, Gore P, Beres E, Porter RW, Preul MC, Spetzler RF, Bambakidis NC (2009) Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery 64:44–51

    Article  Google Scholar 

  13. Chen LF, Yu XG, Bu B, Xu BN, Zhou DB (2011) The retrosigmoid approach to petroclival meningioma surgery. J Clin Neurosci 18:1656–1661

    Article  PubMed  Google Scholar 

  14. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28

    Article  CAS  PubMed  Google Scholar 

  15. Goel A, Muzumdar D (2004) Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. Surg Neurol 62:332–340

    Article  PubMed  Google Scholar 

  16. Hakuba A, Nishimura S, Jang BJ (1988) A combined retroauricular and preauricular transpetrosal transtentorial approach to clivus meningiomas. Surg Neurol 30:108–116

    Article  CAS  PubMed  Google Scholar 

  17. Hitselberger WE, Horn KL, Hankinson H, Brackmann DE, House WF (1993) The middle fossa transpetrous approach for petroclival meningiomas. Skull Base Surg 3:133–135

    Article  Google Scholar 

  18. House WF, De la Cruz A, Hitselberger WE (1978) Surgery of the skull base: transcochlear approach to the petrous apex and clivus. Otolaryngology 86:770–779

    Article  Google Scholar 

  19. Isolan GR, Wayhs SY, Lepski GA, Dini LI, Lavinsky J (2018) Petroclival meningiomas: factors determining the choice of approach. J Neurol Surg B Skull Base 79:367–378

    Article  PubMed  Google Scholar 

  20. Kawase T, Shiobara R (1997) Middle fossa transpetrosal approach to the clivus and acoustic meatus. In: Torrens M (ed) Operative Skull Base Surgery. Churchill Livingstone, Edinburgh, pp 263–278

    Google Scholar 

  21. Kawase T, Toya S, Shiobara R, Mine T (1985) Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857–861

    Article  CAS  PubMed  Google Scholar 

  22. Kawase T, Shiobara R, Toya S (1994) Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir 129:113–120

    Article  CAS  PubMed  Google Scholar 

  23. Li PL, Mao Y, Zhu W, Zhao NQ, Zhao Y, Chen L (2010) Surgical strategies for petroclival meningioma in 57 patients. Chin Med J 123:2865–2873

    PubMed  Google Scholar 

  24. Li D, Hao SY, Wang L, Tang J, Xiao XR, Zhou H, Jia GJ, Wu Z, Zhang LW, Zhang JT (2013) Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir 155:1367–1383

    Article  PubMed  Google Scholar 

  25. Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 56:546–559

    Article  PubMed  Google Scholar 

  26. Magill ST, Rick JW, Chen WC, Haase DA, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW (2018) Petrous face meningiomas: classification, clinical syndromes, and surgical outcomes. World Neurosurg 114:e1266–e1274

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mayur S, Sudheer A, Bharat G, Anil N (2014) A comparison between the Kawase and extended retrosigmoid approaches (retrosigmoid transtentorial and retrosigmoid intradural suprameatal approaches) for accessing the petroclival tumors. A Cadaveric Study. J Neurol Surg B Skull Base 75:171–176

    Article  Google Scholar 

  28. Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: multimodality treatment and outcomes at longterm follow-up. Neurosurgery 60:965–981

    Article  PubMed  Google Scholar 

  29. Osama A, Jonathan W, Krystle T, Morganne M, Bharat G (2016) Morphometric analysis of bone resection in anterior petrosectomies. J Neurol Surg B Skull Base 77:238–242

    Google Scholar 

  30. Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PH (2008) Surgical removal of small petroclival meningiomas. Acta Neurochir 150:431–438

    Article  CAS  PubMed  Google Scholar 

  31. Russell JR, Bucy PC (1953) Meningiomas of the posterior fossa. Surg Gynecol Obstet 96:183–192

    CAS  PubMed  Google Scholar 

  32. Samii M, Ammirati M (1988) The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir 95:6–12

    Article  CAS  PubMed  Google Scholar 

  33. Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A (1989) Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24:12–17

    Article  CAS  PubMed  Google Scholar 

  34. Samii M, Tatagiba M, Carvalho GA (1999) Resection of large petroclival meningiomas by the simple retrosigmoid route. J Clin Neurosci 6:27–33

    Article  CAS  PubMed  Google Scholar 

  35. Samii M, Tatagiba M, Carvalho GA (2000) Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome. J Neurosurg 92:235–241

    Article  CAS  PubMed  Google Scholar 

  36. Samii M, Gerganov V, Giordano M, Samii A (2010) Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev 34:173–179

    Article  PubMed  Google Scholar 

  37. Sekhar LN, Wright DC, Richardson R, Monacci W (1996) Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neuro-Oncol 29:249–259

    Article  CAS  Google Scholar 

  38. Seoane E, Rhoton AL Jr (1999) Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery 44:553–560

    Article  CAS  PubMed  Google Scholar 

  39. Shibao S, Toda M, Orii M, Fujiwara H, Yoshida K (2016) Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach. J Neurosurg 124:432–439

    Article  PubMed  Google Scholar 

  40. Spallone A, Makhmudov UB, Mukhamedjanov DJ, Tcherekajev VA (1999) Petroclival meningioma. An attempt to define the role of skull base approaches in their surgical management. Surg Neurol 51:412–419

    Article  CAS  PubMed  Google Scholar 

  41. Tamura R, Tomio R, Mohammad F, Toda M, Yoshida K (2018) Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach. J Neurosurg 1:1–8

    Google Scholar 

  42. Tomio R, Akiyama T, Ohira T, Horikoshi T, Yoshida K (2014) Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach. Acta Neurochir 156:1847–1852

    Article  PubMed  Google Scholar 

  43. Tomogane Y, Mori K, Izumoto S, Kaba K, Ishikura R, Ando K, Wakata Y, Fujita S, Shirakawa M, Arita N (2013) Usefulness of PRESTO magnetic resonance imaging for the differentiation of schwannoma and meningioma in the cerebellopontine angle. Neurol Med Chir (Tokyo) 53:482–489

    Article  Google Scholar 

  44. Xu F, Ioannis K, Cliff AM, Warren RS, Nicholas CB (2013) Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus 35:E11

    Article  PubMed  Google Scholar 

  45. Yoshida K, Kawase T (1999) Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 91:202–211

    Article  CAS  PubMed  Google Scholar 

  46. Zhao Z, Yuan X, Yuan J, Su J, Wang X, Jiang W, Peng Z, Li X, Liu Q (2016) Retrosigmoid-transtentorial approach for petroclival meningiomas: operative technique and clinical outcome. Chin Neurosurg J 2:21

    Article  Google Scholar 

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Correspondence to Kazunari Yoshida.

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Hassaan, S.A., Tamura, R., Morimoto, Y. et al. Surgical outcomes of anterior cerebellopontine angle meningiomas using the anterior transpetrosal approach compared with the lateral suboccipital approach. Acta Neurochir 162, 1243–1248 (2020). https://doi.org/10.1007/s00701-020-04236-6

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