Skip to main content

Advertisement

SpringerLink
Log in

The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

  • OTOLOGY: Tumors of the Ear and Lateral Skull Base (G Danesi, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Castellano F, Ruggiero G. Meningiomas of the posterior fossa. Acta Radiol Suppl. 1953;104:1–177.

    CAS  PubMed  Google Scholar 

  2. Martinez R, Vaquero J, Areitio E, Bravo G. Meningiomas of the posterior fossa. Surg Neurol. 1983;19(3):237–43.

    Article  CAS  PubMed  Google Scholar 

  3. Thomas NW, King TT. Meningiomas of the cerebellopontine angle. A report of 41 cases. Br J Neurosurg. 1996;10:59–68.

    Article  CAS  PubMed  Google Scholar 

  4. Mazzoni A. The petro-occipital trans-sigmoid approach for lesions of the jugular foramen. Skull Base. 2009;19(1):48–56.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ramachandra P, Tummala MD, Ernesto Coscarella MD, Jacques J, Morcos MD. F.R.C.S. Transpetrosal approaches to the posterior fossa. Neurosurg Focus. 2005;19(2):E6.

    Google Scholar 

  6. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93:146–7.

    Article  CAS  PubMed  Google Scholar 

  7. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20:22–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery. 2000;46(3):567–74.

    Article  CAS  PubMed  Google Scholar 

  9. • Rogers L, et al. Meningiomas: knowledge base, treatment outcomes, and uncertainties: a RANO review. J Neurosurg. 2015;122(1):4–23. Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a paper on systemic therapies for meningioma and a separate article proposing standardized end point and response criteria for meningioma.

  10. • Magill ST, Rick JW, Chen WC, Haase DA, Raleigh DR, Aghi MK, et al. Petrous face meningiomas: classification, clinical syndromes and surgical outcomes. World Neurosurg. 2018. https://doi.org/10.1016/j.wneu.2018.03.194. PFMs present with distinct clinical syndromes based on their location along the petrous face: anterior with trigeminal symptoms, middle with auditory/vestibular symptoms, and posterior with symptoms of mass effect/hydrocephalous. Surgical resection is associated with excellent long-term survival and a low rate of recurrence, which can be managed with radiotherapy.

  11. Roser F, Nakamura M, Dormiani M, Matthies C, Vorkapic P, Samii M. Meningiomas of the cerebellopontine angle with extension into the internal auditory canal. J Neurosurg. 2005;102(1):17–23.

    Article  PubMed  Google Scholar 

  12. Velho V, Agarwal V, Mally R, Palande DA. Posterior fossa meningioma “our experience” in 64 cases. Asian J Neurosurg. 2012;7(3):116–24.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Anil Nanda and Prasad Vannemreddy. Recurrence and outcome in skull base meningiomas: do they differ from other intracranial meningiomas? SKULL BASE/VOLUME 18, NUMBER 42008.

  14. Michael L. DiLuna and Ketan R. Bulsara. Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era. SKULL BASE/VOLUME 20, NUMBER 52010.

  15. Joseph P. Roche et al., Treatment of lateral skull base and posterior cranial fossa lesions utilizing the extended middle cranial fossa approach. Otology. Neurology. 2017;38(5).

  16. He X, Liu W, Wang Y, et al. Surgical management and outcome experience of 53 cerebellopontine angle meningiomas. Cureus. 2017;9(8):e1538. https://doi.org/10.7759/cureus.1538.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Couldwell WT, Cole CD, Al-Mefty O. Patterns of skull base meningioma progression after failed radiosurgery. J Neurosurg. 2007;106(1):30–5.

    Article  PubMed  Google Scholar 

  18. Sanai N, McDermott MW. A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg. 2010;112:907–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ospedale Nuovo di Legnano, ENT & Skull Base Department, via Papa Giovanni Paolo II, Legnano, 20025, MI, Italy

    Roberto Pareschi

  2. Ospedali Riuniti di Bergamo, ENT & Skull Base Department, Bergamo, Italy

    Giovanni Danesi, Rachele Bivona & Catalina Iglesias Valera

  3. Ospedale Nuovo di Legnano, Neurosurgical Unit, via Papa Giovanni Paolo II, Legnano, 20025, MI, Italy

    Roberto Stefini

Authors
  1. Roberto Pareschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Danesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Stefini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachele Bivona
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catalina Iglesias Valera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Pareschi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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 OTOLOGY: Tumors of the Ear and Lateral Skull Base

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pareschi, R., Danesi, G., Stefini, R. et al. The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results. Curr Otorhinolaryngol Rep 7, 65–72 (2019). https://doi.org/10.1007/s40136-019-00230-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-019-00230-4

Keywords

Search

Navigation