There was also a significant relationship between bone erosion and the number of cn deficits observed. Please include this information when citing this paper. 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. Key words retrosigmoid approach petroclival meningioma video manuscript submitted september 30, 20. Petroclival meningiomas pcms are technically challenging lesions. The treatment is very difficult due to its location that involves the central region of the. 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.
Developments in skull base surgery, neuroradiology and intensive care have led to a breakthrough in the. We retrospectively assessed the surgical outcomes of pcms based on a tumor classification to. Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection. Tumors defined as petroclival are those with basal attachments at or medial to the skull base foramina of cranial nerves v through ix, x. No extension beyond anterior margin of iam into into the iac. Petroclival meningiomas were originally considered largely unresectable. Microneurosurgery, outcome, petroclival meningioma, skull base, surgical approach, tentorium incision background petroclival meningiomas pcms account for 3 % to 10 %. Treatment strategy for petroclival meningiomas based on a. Thus, we define petroclival meningiomas as those originating at the upper twothirds of the clivus true petroclival meningiomas. Although the standard retrosigmoid approach is one of the most effective approaches, this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa. Petroclival meningiomas neurosurgery oxford academic.
Among these, petroclival meningioma pcm can represent an astonishing example. David petroclival meningiomas are among the most difficult cranial base lesions to treat. 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. Petroclival meningiomas remain one of the most challenging surgical lesions of the skull base.
Intracranial rosaidorfman disease with the petroclival. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. Endoscopic endonasal approach for transclival resection of. Clinical outcomes and survival analysis for petroclival. Petroclival meningiomas pcms have always been a challenge for surgeons because of their difficult anatomical location. 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. Petroclival meningiomas are rare and account for less than 2% of all meningiomas. Volumetric changes and clinical outcome for petroclival. We report a case of unilateral cervicofacial dyskinesias due to an ipsilateral petroclival meningioma.
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. Petroclival meningiomas pcms are regarded as one of the most formidable challenges in neurosurgery. Total removal of tumor of right retrosigmoid approach using neurophysiologic monitoring. 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. Most are benign and account for 33% of all newly diagnosed brain tumors. Herein, we present the 8th case of intracranial rdd with the petroclival and parasellar involvement mimicking multiple meningiomas patient concerns. The topics related to general considerations, clinical presentation, evaluation, and indications for surgery are discussed in the chapter titled petroclival meningioma.
Petroclival meningiomas are vaguely defined as tumours arising from the anteromedial zone to the internal auditory meatus. To the best of our knowledge, only 7 cases of petroclival rdd have been reported so far. Petroclival meningioma arises in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve. 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. This report subclassifies petroclival meningiomas based on their origin determined by using radiological and intraoperative findings. We provide a modified surgical technique called retrosigmoidtranstentorial approach rtta to solve these problems. Most studies report that the period of symptoms before diagnosis averages between 2.
A large case series 109 patients was published in 1996. Large petroclival meningioma with extension into supratentorial space. Nerve deficits after petroclival meningioma surgery. The operative mortality was very high but could be reduced with development of new diagnostic and surgical procedures 4, 8, 12, 16, 19, 23, 36, 38. These tumors displace the brain stem and the basilar artery to the opposite side. Petroclival meningiomas are surgically challenging tumors due to the proximity to cranial nerves, major blood vessels, and the brainstem with considerably high. The adjacent petrous apex demonstrates low t1 and t2 signal, and contrast. Petrosal approaches were reserved for patients with tumor extension into the middle fossa. Upload and share your own cases, ask questions and discuss. Over the past three decades, advances in microsurgical techniques, new operating microscopes, ultrasonic aspirators, intraoperative neuromonitoring, and advances in intensive care and microsurgical anatomy have led to better outcomes than has the natural history of the disease, with. The most frequent tumor is the petroclival meningioma, followed by chondrosarcomas, chordomas, schwannomas of the cranial nerves v and vii, and other malignant tumors 2, 15, 16, 20, 24.
Petroclival meningioma originates from dura mater which is located at the slope and the petrous apex. Cn iv will be encased and may have to be sacrificed. Patients with mediumsize meningiomas had an aggregate cn deficit averaging 1. The surgical management of petroclival meningioma remains. Preoperative nf and postoperative lower row mr images demonstrating a large petroclival meningioma extending below the iam in a patient with intact hearing, prompting a posterior petrosal approach for resection. The typical presentation of a petroclival meningioma is that of an insidious onset.
In spite of all recent advances in neurosurgery, neuroradiology, and radiotherapy, the morbidity of surgical treatment of large petroclival. Site related relapses with planum sphenoidale or olfactory groove meningioma, tumor recurrence reported in 7. There are several lesions arising in the petroclival region. Petroclival meningiomas remain a formidable challenge for. Petroclival meningioma skull based tumor looking for. Petroclival meningiomas diagnosis, treatment, and results. Petroclival meningiomas may be in the posterior fossa alone, or may span the middle and posterior cranial fossae. Within the left cerebellopontine angle, there is a 21 x 12 mm extraaxial lesion that is of intermediate t1 and t2 signal intensity and demonstrates avid homogeneous contrast enhancement with a dural tail. Unlimited access to the largest elibrary of professional videos, images, documents, courses. Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. Some patients have no symptoms at all, and others may have headaches, double vision, facial numbness, hearing loss, andor dizziness.
The role of radiology in providing precise indications regarding the tumour site and aggressiveness plays a major part in guiding the subsequent therapeutic process. Pdf the surgical management of petroclival meningioma remains challenging, due to the difficulty of. Subtemporal transtentorial petrosalapex approach for giant petroclival meningiomas. Surgical management of petroclival tumors neupsy key. Treatment usually involves a combination of surgery and radiation treatment. These patients require serial mri scans for their entire life. 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. Rosaidorfman disease rdd is a rare nonlangerhans cell histiocytosis. 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. A variety of pathologies may originate in the petroclival area, including meningiomas, schwannomas, chordomas, chondrosarcomas, carcinomas, aneurysms and others. The most frequent tumor is the petroclival meningioma, followed by chondrosarcomas, chordomas. In the rest of 6 patients, a partial removal of the meningioma was performed simpson grade iv.
Petroclival meningioma right transpetrosal approach. A 32 year old left handed woman complained about left sided. We determined whether differences in smcv drainages patterns affected the perioperative management of petroclival meningioma. Posterior petrosectomy in addition, the general resection techniques for removal of petroclival meningiomas are discussed in the petroclival meningioma.
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. Drainage patterns of the superficial middle cerebral vein. Clinical outcomes and survival analysis for petroclival meningioma. The petroclival area is a complex region situated at the junction of adjacent parts of sphenoid, temporal and occipital bones. Inferiorly, the lesion extends to the jugular foramen. Surgical removal of large petroclival meningiomas presents the neurosurgeons an enormous challenge. Retrosigmoidtranstentorial approach for petroclival.
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