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Seventeen patients with petroclival meningioma were operated on through a middle fossa transpetrous approach. This approach exposes the anterior cerebellopontine angle through a middle fossa craniotomy with removal of the petrous apex medial to the cochlea and petrous carotid artery. This approach may be enlarged by transection of the superior petrosal sinus and tentorium. The surgical technique and application of the middle fossa transpetrous approach for petroclival meningiomas is presented. 相似文献
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Ramina R Neto MC Fernandes YB Silva EB Mattei TA Aguiar PH 《Acta neurochirurgica》2008,150(5):431-439
Summary Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or
radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial.
Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours
is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because
the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas
(diameter ≤ 2.8 cm) treated with radical surgical removal. Total resection (Simpson’s Grade 1) [43] was possible with minimal
morbidity and no mortality.
Background. We present a series of small petroclival meningiomas (SPM) treated by radical surgical removal and compare the outcome with
other management modalities proposed for these lesions.
Methods. Eighteen patients with SPM were surgically treated at our department of neurological surgery. The tumours were classified
as small when they had a diameter < 3.0 cm. Headaches (n = 12), diplopia (n = 8), facial hypoaesthesia (n = 3) and tinnitus (n = 6) were the most frequent symptoms at presentation. The approaches used were retrosigmoid (n = 14), fronto-orbito-zygomatic (n = 3) and presigmoid (n = 1). The post-operative follow-up ranged from 1 to 110 months (mean 41.8 months).
Findings. Radical tumour resection (Simpson’s Grades 1 and 2) was achieved in all patients. There was no major morbidity or mortality
related to the surgical procedure. Transient abducent nerve palsy was the only post-operative complication. The pre-operative
cranial nerves deficits improved after surgery. Only one patient had persistent diplopia postoperatively.
Conclusion. Radical surgical removal of SPM is possible with minimal morbidity and may cure the patient. The effectiveness and outcome
of surgery for small petroclival meningiomas should be compared with series treated by radiosurgery.
Correspondence: Ricardo Ramina, R. Goncalves Dias 713, 80240340 Curitiba, Brazil. 相似文献
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The treatment of petroclival meningiomas is still a matter of controversy in literature. In the last decades, many approaches
have been introduced. Our strategy for the treatment of such tumors having large supratentorial extension with encasement
of the internal carotid artery or compression of optic and oculomotor nerves has evolved in the attempt to improve the outcome.
Currently, we favor a surgical technique consisting of two steps. As first step, we perform a retrosigmoid suprameatal approach
in order to resect the posterior part of the tumor and obtain brainstem decompression. In the second step, carried out after
patient’s recovery from the first surgery, we remove the supratentorial portion of the lesion using a frontotemporal craniotomy
to achieve the decompression of the optic nerve, oculomotor nerve, and carotid artery. The retrosigmoid suprameatal approach
allows for adequate brainstem decompression: the tumor itself creates a surgical channel increasing the accessibility to the
lower and upper petroclival surface. Moreover, this route allows for early visualization of cranial nerves in the posterior
fossa and safe tumor removal under direct visual control, reducing the risk of postoperative deficits. Via the simple and
safe frontotemporal craniotomy, the supratentorial part of the lesion can be removed thus avoiding the need of invasive approaches.
We propose a two-stage surgery for treatment of petroclival meningiomas combining two simple routes such as retrosigmoid suprameatal
and frontotemporal craniotomy. This approach reflects our philosophy to use simple and less invasive approaches in order to
preserve neurological function and a good quality of life of the patient. 相似文献
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Neurosurgical Review - The treatment of petroclival meningiomas is still a matter of controversy in literature. In the last decades, many approaches have been introduced. Our strategy for the... 相似文献
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Mogi A Kosaka T Yamaki E Hirato J Kuwano H 《General thoracic and cardiovascular surgery》2012,60(4):233-236
Giant cell tumors (GCTs) are rare neoplasms, most commonly arising in the metaphysis/epiphysis of long bones. They consist
of multinucleated giant cells with surrounding spindle-shaped mononuclear stromal cells. GCTs rarely appear in the ribs. We
report a case of a GCT originating from the anterior arc of the fourth rib in a 31-year-old man who presented with a progressively
growing thoracic mass in the left anterior chest wall. Thoracotomy involving en bloc resection of the chest wall and tumor
and a reconstruction of the chest wall were performed. 相似文献
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Summary
Background. Petroclival meningiomas are vaguely defined as tumours arising from the antero-medial zone to the internal auditory meatus.
This report subclassifies petroclival meningiomas based on their origin determined by using radiological and intra-operative
findings.
Method. Ninety-one patients with petroclival meningioma underwent surgery via the anterior transpetrosal approach. The Meckel’s cave
was routinely opened. Tumour origin was classified into four subtypes according to the main attachment and trigeminal nerve
deviation into, upper clivus (UC), cavernous sinus (CS), tentorium (TE), and petrous apex (PA). Their characteristic clinical
symptoms and anatomical features were investigated.
Findings. The characteristic symptom was ataxia in the UC type (37.5%), abducens nerve palsy in the CS type (64.3%) and trigeminal
neuropathy, mainly neuralgia in the PA type (80.0%) with a higher statistical difference from other subtypes. The rate of
tumour invasion into Meckel’s cave reached 70.3% in average, with the lowest rate in the PA type (25.0%). The rate of middle
fossa extension was the highest in the TE type (59.5%). The middle fossa approach was considered to be ideal for UC and TE
types because of easier access to the Meckel’s cave. Radical dissection without complications was difficult in the CS type.
Both the anterior transpetrosal approach and the lateral suboccipital approach could be indicated in the PA type due to the
rare invasion of Meckel’s cave and middle fossa, and frequent extension into the internal auditory meatus.
Conclusions. This classification is useful to predict the relation between the tumour and the cranial nerves based on symptoms and images.
The anterior transpetrosal approach could be used for all four subtypes and with an absolute indication in the UC and TE types
showing middle fossa extension.
Correspondence: Takeshi Kawase, M.D., Ph.D., Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi,
Shinjukuku, Tokyo 160-8582, Japan. 相似文献
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A common surgery for giant coronary artery aneurysms includes aneurysmal ligation and coronary artery bypass grafting. We report a patient with such an aneurysm involving the left main trunk in whom the aneurysmal characteristics precluded this approach. Surgical strategy was modified and the aneurysmal sac was dissected open to define the coronary vasculature before ligating the aneurysm and completing the bypass operation. 相似文献
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Background
Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult.Methods
Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3 years (47–88 years). The average observation period was 55.4 months (22–132 months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence.Results
Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11 years after an operation involving a Simpson grade II resectionConclusion
Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.13.
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Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas selective pyramid resection and radicality 总被引:14,自引:0,他引:14
Summary Fourty-two patients with petroclival meningioma were operated upon by the middle fossa transpetrosal-transtentorial approaches since 1977. Half of those showed tumour extension into the middle fossa and one-third in the cavernous sinus. Seventeen (40%) had a large tumour of 40 mm in diameter or larger, and 8 of those had a broad attachment from the clivus to petrous pyramid of the temporal bone. The site of pyramid resection was selected from three types, depending on the tumour location and the patients' pre-operative hearing. There was no surgical mortality. Significant risk of lower cranial nerves palsy was minimal and useful hearing was preserved in 18 out of 21 patients. The follow-up, an average of 4 and a half years, showed tumours were completely eradicated in 32 patients (76%) and there was regrowfh in 3 (7%). Thirty-four patients (81%) were independent, 3 disabled and only one died of rapid tumour regrowth. The most influential factor on surgical results was the extent to which the tumour had invaded the brain stem. The presence or absence of arterial encasement and of peritumoural oedema on MRI were important in the selection for radical surgery. 相似文献
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Da Li Shu-Yu Hao Liang Wang Jie Tang Xin-Ru Xiao Hui Zhou Gui-Jun Jia Zhen Wu Li-Wei Zhang Jun-Ting Zhang 《Acta neurochirurgica》2013,155(8):1367-1383
Background
Surgical management of petroclival meningiomas is challenging. Various and inconsistent outcome and prognostic factors of the lesions have been evaluated previously. In the present study, the surgical outcome, philosophy, and experience of petroclival meningiomas are detailed based on a large patient series.Methods
A series of 259 patients with petroclival meningiomas (70 males and 189 females) were surgically treated. Clinical charts and radiographs were reviewed. Follow-up results were evaluated.Results
The preoperative Karnofsky Performance Scale (KPS) score was 74.2?±?10.5. The mean tumor size was 4.3?±?1.0 cm. The gross total resection (GTR) rate was 52.5 %. During a mean follow-up period of 55.3 months, recurrence/progression (R/P) occurred in 11 patients. The recent KPS score was 78.4?±?22.7, it improved in 139 (57.2 %) patients and stabilized in 53 (21.8 %) patients, and 201 (82.7 %) patients lived independently. The risk factors affecting the KPS score included (but were not limited to) age?≥?60, preoperative KPS?≤?60, and brainstem edema. The adverse factors contributing to R/P-free survival included (but were not limited to) non-total resection and the absence of the subarachnoid space. The R/P-free survival rate was 94.5 % at 5 years and 91.2 % at 9 years. The overall survival rate was 94.7 % at 5 years and 94.7 % at 9 years.Conclusions
Favorable outcomes from petroclival meningiomas could be achieved by microsurgery. Neurological function and quality of life were prioritized, and GTR was attempted. Risk factors should be considered in surgical schemes, and tumor recurrence should be aggressively monitored and treated. 相似文献16.
目的探讨前床突区手术临床应用解剖,提高前床突区肿瘤的治疗效果。方法回顾性总结1998-2004年收治的采用前外侧硬脑膜外入路手术的前床突脑膜瘤12例,其中视力减退者10例,头痛者11例。采用眶上翼点联合入路,肿瘤累及海绵窦者采用额颞眶颧联合入路。磨除前床突。硬脑膜外阻断肿瘤基底部血供。硬脑膜下切除肿瘤。结果本组患者全切除8例,次全切除3例,部分切除1例。全组无手术死亡。术前视力明显减退的10例患者,术后6例明显好转,2例改善,1例无变化,1例较术前恶化,其中术后视力无改变和视力恶化的2例均为术前有明显视神经萎缩的患者。结论前床突脑膜瘤采用前外侧硬脑膜外入路,磨除前床突,有利于肿瘤基底部的血供阻断以及前床突下肿瘤与颈内动脉的分离。眶上翼点联合入路可明显减小手术对脑组织的牵拉,有利于大型肿瘤上极的显露。 相似文献
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体表巨大血管瘤的手术切除与整复治疗 总被引:5,自引:0,他引:5
目的 通过45例巨型血管瘤的手术治疗,阐明血管瘤选用手术切除是一种带有根治性的有效治疗方法。方法 ①术前放射数字减影(DSA)检查,可明确诊断了,了解病变范围,有利于手术设计等。②术中具体操作宜采用“假包膜剥率法”。③应用整复手术进行创面修复。结果 45例手术,一期治愈27例,二例治愈13例,治愈率达89%。术后随访时间最长已达8年,无复发,疗效好。结论 术前DSA检查结果是制定手术方案的重要依据 相似文献
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Background Surgical management of giant medial sphenoid meningiomas (≥5 cm in maximum dimension) is extremely challenging due to their
intimate relationship with vital neural structures like the optic nerve, cranial nerves of the cavernous sinus and the cavernous
internal carotid artery. Their surgical management is presented incorporating a radiological scoring system that predicts
the grade of tumour excision.
Materials and methods 20 patients of giant medial sphenoidal wing meningioma (maximum tumour dimension range: 5.2 to 9.5 cm; mean maximum dimension = 6.12 ± 1.06 cm)
with mainly visual and extraocular movement deficits, and raised intracranial pressure, underwent surgery. A preoperative
radiological scoring system (range 1–12) was proposed considering tumour volume (using Kawamoto’s method); extension into
the surrounding surgical corridors; extent of cavernous sinus invasion (based on the tumour relationship to the cavernous
internal carotid artery); associated hyperostosis and/or >50% calcification; and, associated brain oedema. Both the conventional
frontotemporal craniotomy (n = 13) and its extension to orbitozygomatic osteotomy (n = 7) were utilized. The cavernous sinus was explored in 4 patients and the hyperostotic sphenoid ridge drilled in five patients.
Findings Total excision was achieved in nine patients; small tumour remnants within the cavernous sinus, interpeduncular fossa or suprasellar
cistern were left in eight patients; and less than 10% of tumour was left in three patients. A patient with a completely calcified
meningioma died due to myocardial infarction. When the preoperative radiological score was ≥7, there was considerable difficulty
in achieving total tumour excision. A mean follow of 17.58 ± 15.05 months revealed improvement in visual acuity/field defects
in three, stabilisation in 11, and deterioration of ipsilateral visual acuity in five patients. Symptoms of raised pressure,
cognitive dysfunction, aphasia and proptosis showed improvement.
Conclusion A relatively conservative approach to these extensive lesions resulted in good outcome in a majority of our patients. Both
the standard as well as skull base approaches may be utilized for successful removal of giant medial sphenoidal wing meningiomas.
A preoperative radiological score of ≥7 predicts a greater degree of difficulty in achieving complete surgical extirpation. 相似文献