Skip to main content

Advertisement

SpringerLink
Log in

A clinical study of ocular motor nerve functions after petroclival meningioma resection

  • Original Article - Tumor - Meningioma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Ocular motor dysfunction is one of the most common postoperative complications of petroclival meningioma. However, its incidence, recovery rate, and independent risk factors remain poorly explored.

Methods

A prospective analysis of 31 petroclival meningiomas was performed. Operative approaches were selected by utilizing a new 6-region classification of petroclival meningiomas we proposed. Two scores were used to evaluate the functions of the oculomotor and abducens nerves. Pearson correlation analysis and binary logistic regression analysis were used to identify independent risk factors for intraoperative oculomotor and abducens nerve injury.

Results

Postoperative new-onset dysfunctions in the pupillary light reflex and eye/eyelid movements as well as abducens paralysis were detected in eight (25.8%), ten (32.3%) and twelve (38.7%) cases, respectively. Their corresponding recovery rates after 6 months of follow-up were 75% (6/8), 80% (8/10), and 83.3% (10/12), respectively, and their mean times to start recovery were 4.03, 2.43, and 2.5 months, respectively. Tumor invasion into the suprasellar region/sphenoid sinus was the only risk factor for dysfunctions in both the pupillary light reflex (p = 0.001) and eye/eyelid movements (p = 0.002). Intraoperative utilization of the infratrigeminal interspace was the only risk factor for dysfunction in eyeball abduction movement (p = 0.004).

Conclusions

Dysfunctions of the oculomotor and abducens nerves recovered within 6 months postoperatively. Tumor extension into the suprasellar region/sphenoid sinus was the only risk factor for oculomotor nerve paralysis. Eye/eyelid movements were more sensitive than the pupillary light reflex in reflecting nerve dysfunctions. Intraoperative utilization of the infratrigeminal interspace was the only risk factor for abducens nerve paralysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ATPA:

Anterior transpetrosal approach

CPA:

Cerebellopontine angle

CS:

Cavernous sinus

ITriI:

Infratrigeminal interspace

ITroI:

Infratrochlear interspace

OZ:

Orbitozygomatic

PA:

Petrous apex

PSTPA:

Presigmoid transpetrosal approach

STroI:

Supratrochlear interspace

UC:

Upper clivus

References

  1. Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22(3):510–517

    Article  CAS  Google Scholar 

  2. Aoyagi M, Kawano Y, Tamaki M, Tamura K, Ohno K (2013) Combined extradural subtemporal and anterior transpetrosal approach to tumors located in the interpeduncular fossa and the upper clivus. Acta Neurochir 155(8):1401–1407

    Article  Google Scholar 

  3. 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  Google Scholar 

  4. Borghei-Razavi H, Tomio R, Fereshtehnejad SM et al (2016) Pathological location of cranial nerves in petroclival lesions: how to avoid their injury during anterior petrosal approach. J Neurol Surg B Skull Base 77(1):6–13

    PubMed  Google Scholar 

  5. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84(1):20–28

    Article  CAS  Google Scholar 

  6. Hao S, Tian R, Wu Z et al (2015) Clinical characteristics and prognosis factors analysis for post-operative ptosis of sphenocavernous meningiomas: a single institution study. Clin Neurol Neurosurg 131:35–41

    Article  Google Scholar 

  7. Ichimura S, Hori S, Hecht N, Czabanka M, Vajkoczy P (2016) Intradural anterior transpetrosal approach. Neurosurg Rev 39(4):625–631

    Article  Google Scholar 

  8. Kaspera W, Adamczyk P, Ślaska-Kaspera A, Ładziński P (2015) Usefulness of intraoperative monitoring of oculomotor and abducens nerves during surgical treatment of the cavernous sinus meningiomas. Adv Med Sci 60(1):25–30

    Article  Google Scholar 

  9. Katayama M, Kawase T, Sato S, Kojima A, Yoshida K (2002) Abnormal course of the oculomotor nerve on the clivus combined with a petroclival meningioma: case report. Skull Base 12(3):141–144

    Article  Google Scholar 

  10. Kawase T, Shiobara R, Ohira T, Toya S (1996) Developmental patterns and characteristic symptoms of petroclival meningiomas. Neurol Med Chir (Tokyo) 36(1):1–6

    Article  CAS  Google Scholar 

  11. Kissel JT, Burde RM, Klingele TG, Zeiger HE (1983) Pupil-sparing oculomotor palsies with internal carotid-posterior communicating artery aneurysms. Ann Neurol 13(2):149–154

    Article  CAS  Google Scholar 

  12. Meling TR, Da BM, Scheie D, Helseth E, Smoll NR (2019) Meningioma surgery-are we making progress. World Neurosurg 125:e205–205e213

    Article  Google Scholar 

  13. Morisako H, Goto T, Ohata H, Goudihalli SR, Shirosaka K, Ohata K (2018) Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach. Neurosurg Focus 44(4):E11

    Article  Google Scholar 

  14. 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  Google Scholar 

  15. Scott AB, Kraft SP (1985) Botulinum toxin injection in the management of lateral rectus paresis. Ophthalmology 92(5):676–683

    Article  CAS  Google Scholar 

  16. Seifert V (2010) Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years. Acta Neurochir 152(7):1099–1116

    Article  Google Scholar 

  17. Spetzler RF, Daspit CP, Pappas CT (1992) The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76(4):588–599

    Article  CAS  Google Scholar 

  18. Xiao X, Zhang L, Wu Z et al (2013) Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach. Neurosurg Rev 36(4):587–593 discussion 593-4

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Liang Wang and Qing Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Liang Wang, Qing Zhang, Jian-Cong Weng, Liang-Peng Chen, Da Li, Gui-Jun Jia, Li-Wei Zhang, Zhen Wu, Wang Jia & Jun-Ting Zhang

  2. China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Liang Wang, Qing Zhang, Jian-Cong Weng, Liang-Peng Chen, Da Li, Gui-Jun Jia, Li-Wei Zhang, Zhen Wu, Wang Jia & Jun-Ting Zhang

  3. Center of Brain Tumor, Beijing Institute for Brain Disorders, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Liang Wang, Qing Zhang, Jian-Cong Weng, Liang-Peng Chen, Da Li, Gui-Jun Jia, Li-Wei Zhang, Zhen Wu, Wang Jia & Jun-Ting Zhang

  4. Beijing Key Laboratory of Brain Tumor, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Liang Wang, Qing Zhang, Jian-Cong Weng, Liang-Peng Chen, Da Li, Gui-Jun Jia, Li-Wei Zhang, Zhen Wu, Wang Jia & Jun-Ting Zhang

Authors
  1. Liang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jian-Cong Weng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liang-Peng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Da Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gui-Jun Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li-Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jun-Ting Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun-Ting Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University, KY2014-021-02) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Tumor - Meningioma

Electronic supplementary material

ESM 1

(DOCX 15 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, L., Zhang, Q., Weng, JC. et al. A clinical study of ocular motor nerve functions after petroclival meningioma resection. Acta Neurochir 162, 1249–1257 (2020). https://doi.org/10.1007/s00701-020-04262-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04262-4

Keywords

Search

Navigation