Abstract
The surgical management of intradural clival tumours is difficult due to the relative inaccessibility of the clivus through traditional neurosurgical approached, and the intimate relationship of such tumours to critical neurovascular and brainstem structures. This report concentrates on the experience with clival menigiomas, which are the most common intradural clival tumours. Between July 1983 and July 1990, 52 patients with petroclival meningiomas underwent surgical excision of their tumours. A variety of skull base approaches were utilized to obtain wide tumour exposure with minimal brain retraction. Large or giant tumours required multiple approaches and staged removal of tumour. Tumour resection was evaluated by a standard protocol of postoperative MR or CT scans. Total tumour resection was achieved in 38 cases (73%), subtotal resection in 11 (21%) and partial resection in 3 (6%). Follow-up has ranged from 4 to 83 months. Two patients had recurrence of tumour requiring re-operation with one receiving additional external beam radiation. Two postoperative deaths occurred, one from pheumonia and another from infectious complications. The most common postoperative morbidity were lower cranial nerve palsy, aspiration peumonia and temporary hemiparesis.
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References
Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22: 510–517
Campbell E, Whitfield RD (1948) Posterior fossa meningiomas. J Neurosurg 5: 131–153
Cherrington M, Schneck SA (1966) Clivus meningiomas. Neurology 16: 86–92
Cushing HW, Eisenhardt L (1938) Meningiomas: their classification, regional behaviour, life history and surgical end results. Ch C Thomas, Springfield, 111., pp 3–387
Hakuba A, Nishimura S, Taneka K, Kish H, Nakamura T (1977) Clivus meningioma. Six cases of total removal. Neurol Med Chir 17: 63–77
House W, Hitselberger W (1976) The transcochlear approach to the skull base. Arch Otolaryngol 102: 334–342
Mayberg MR, Symon L (1986) Meningiomas of the clivus and apical petrous bone. Report of 35 cases. J Neurosurg 65: 160–167
Moller RA (1987) Electrophysiological monitoring of cranial nerves in operations in the skull base. In: Sekhar LN, Schramm VL (eds) Tumors of the cranial base, diagnosis and treatment. Futura Publishing Co., Mount Kisco, NY, pp 123–132
Russell JR, Bucy PC (1953) Meningiomas of the posterior fossa. Surg Gynecol Obstet 96: 183–1953
Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A (1989) Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24: 12–17
Sekhar LN, Estonillo R (1986) Transtemporal approach to the skull base: An anatomical study. Neurosurgery 19: 799–808
Sekhar LN, Jannetta PJ (1987) Petroclival and medial tentorial meningiomas. In: Sekhar LN, Schramm VL (eds) Tumors of the cranial base, diagnosis and treatment. Futura Publishing Co., Mount Kisco, NY, pp 623–640
Sekhar LN, Jannetta PJ, Burkhart L et al (1990) Meningiomas involving the clivus: a 6-year experience with 41 patients. Neurosurgery 27: 764–781
Sekhar LN, Samii M (1986) Petroclival and medial tentorial meningiomas. In: Scheuremann H, Schurmann K, Helms J (eds) Tumors of the skull base, extra and intracranial surgery of skull base tumours. Walter de Gruyter, Berlin, pp 141–158
Sekhar LN, Schramm VL, Jones NF (1987) Subtemporal-preauricular infratemporal foassa approach to large lateral and posterior cranial base neoplasms. J Neurosurg 66: 488–499
Sekhar LN, Sen CN, Jho HD, Janecka IP (1989) Surgical treatment of intracavernous neoplasms: a four year experience. Neurosurgery 24: 18–30
Sen, Sekhar LN (1990) An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery 27: 197–202
Ya§argil MG, Martara RW, Curcic M (1980) Meninginomas of basal posterior cranial fossa. In: Krayenbiihl H et al (eds) Advances and technical standards in neurosurgery, Vol 7. Springer, Wien New York, pp 3–115
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© 1991 Springer-Verlag
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Javed, T., Sekhar, L.N. (1991). Surgical Management of Clival Meningiomas. In: Koos, W., Richling, B. (eds) Processes of the Cranial Midline. Acta Neurochirurgica Supplementum, vol 53. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9183-5_28
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DOI: https://doi.org/10.1007/978-3-7091-9183-5_28
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-9185-9
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