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Sohum K Desai, Da'Marcus Baymon, Eric Sieloff, Kenneth Maynard, Marc Moisi, Achal P Patel, Joel T Patterson
AIMS: Lateral transtemporal approaches are useful for addressing lesions located ventral to the brainstem, especially when the pathologic diagnosis of the tumor dictates that a gross or near total resection improves outcomes. One approach, the presigmoid approach receives little attention in the pediatric population thus far. We sought to characterize morphometric changes, particularly the clival depth and the petroclival Cobb angle, that occur in the temporal bones of children and draw implications about doing a presigmoid approach in children...
April 2016: Journal of Pediatric Neurosciences
Tanya E Sassun, Andrea G Ruggeri, Roberto Delfini
BACKGROUND: The evolution of Petroclival Meningiomas (PMs) surgical treatment has lead nowadays to a tendency to abandon complex petrous approaches and return to "less aggressive" skull base approaches. OBJECTIVE: To propose a PMs classification and establish the role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine (CSIPR) approach in the treatment of PMs rigorously matching the anatomical definition. METHODS: A retrospective analysis was conducted of 51 cases of PMs strictly adhering to the anatomical definition, operated on from January 1990 to December 2011...
August 24, 2016: World Neurosurgery
L H Chen, Y Yang, Q Wei, Y J Li, W D Li, J B Gao, B Yu, H Zhao, R X Xu
OBJECTIVE: With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach...
February 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Walter C Jean, Daniel R Felbaum, Amjad Anaizi, Timothy R DeKlotz
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. 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 meningiomas are medially-situated and positioned mainly behind the clivus. For this subset of petroclival meningiomas, a transclival approach may be preferable...
2016: Curēus
Aurel Hasanbelliu, Norberto O Andaluz, Alberto Di Somma, Jeffrey T Keller, Lee Zimmer, Myles L Pensak, Ravi Samy, Mario Zuccarello
INTRODUCTION: Petroclival tumors and ventrolateral lesions of the pons present a unique surgical challenge. We aimed to provide qualitative and quantitative anatomic analyses of anterior petrous apicectomy through the transcranial middle fossa (TMF) and the extended endoscopic transphenoidal-transclival (EETT) approaches. METHODS: Ten cadaveric silicon-injected cadaver heads were used for this study. The petrous apex and the clivus were drilled extradurally through both middle fossa and endonasal approaches...
August 2016: Neurosurgery
G Chen, W W Zhai, Z Q Yu
OBJECTIVE: To investigate varying patterns of intracranial pressure(ICP)after giant meningioma resection and analyze the causes of the variation of ICP in different postoperative phases. METHODS: Clinical data, surgical approachs and the ICP monitoring data of 7 patients with giant meningioma in different positions who were admitted to the First Affiliated Hospital of Soochow University from October 2013 to July 2014 and received microsurgical resection via different approachs were analysed retrospectively...
June 28, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Caroline Hayhurst, Michael E Sughrue, Pankaj A Gore, Phillip A Bonney, Joshua D Burks, Charles Teo
AIM: Reconstruction technique advances have created renewed enthusiasm for the expanded endonasal approach (EEA). However, as with any new technique, early experiences inevitably lead to more selective use of these techniques. We reviewed our experience of the expanded endonasal endoscopic approach for skull base meningiomas and place it in context of the literature. MATERIAL AND METHODS: We performed retrospective review of all endonasal cases performed at our center for histologically proven meningioma...
2016: Turkish Neurosurgery
Ramsey Ashour, Stephen Reintjes, Michael S Park, Sananthan Sivakanthan, Harry van Loveren, Siviero Agazzi
BACKGROUND: Although intraoperative magnetic resonance imaging (iMRI) increasingly is used during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. METHODS: Medical records were reviewed retrospectively on all neurosurgical cases performed at our institution in the IMRIS iMRI suite between April 2014 and July 2015. RESULTS: During the study period, the iMRI suite was used for 71 skull base tumors...
September 2016: World Neurosurgery
Ariyan Pirayesh, Ioannis Petrakakis, Peter Raab, Manolis Polemikos, Joachim K Krauss, Makoto Nakamura
OBJECTIVE: Despite advances in skull base surgery, surgical removal of petroclival meningiomas (PCM) still poses a considerable neurosurgical challenge with regard to postoperative morbidity and the patients' long-term outcome. Knowledge of imaging features for PCM that might help to predict common risk factors encountered with tumor resection preoperatively is limited. The aim of this study was to clarify whether MRI features of PCM might predict tumor resectability and clinical outcome...
August 2016: Clinical Neurology and Neurosurgery
Katsuhiro Mizutani, Masahiro Toda, Kazunari Yoshida
BACKGROUND: The anterior transpetrosal approach (ATPA) has been used in the resection of petroclival meningioma (PCM) for more than 20 years. Although PCM sometimes involves the petrosal vein and its preservation has been an important issue, the precise risk of petrosal vein sacrifice and subsequent venous complications associated with the use of the ATPA in patients with PCM has not yet been elucidated. METHODS: We used computed tomographic (CT) digital subtraction venography (DSV) in the retrospective analysis of the petrosal vein and its tributaries in patients with PCM before and after surgery...
September 2016: World Neurosurgery
André Beer-Furlan, Ralph Abi-Hachem, Ali O Jamshidi, Ricardo L Carrau, Daniel M Prevedello
Petroclival meningiomas are challenging lesions to manage independently of the selected surgical approach and are unique tumors in the type of pathological displacement of the surrounding anatomy. They also represent one of the most controversial entities with regard to approach selection, especially when deciding between an open versus endonasal route. When choosing an approach to the intradural portion of the petroclival region, the location of critical neurovascular structures relative to the lesion must be anticipated, including the abducens and trigeminal nerves...
December 2016: Journal of Neurosurgical Sciences
Matthew L Carlson, Brendan P O'Connell, Joseph T Breen, Cameron C Wick, Colin L Driscoll, David S Haynes, Reid C Thompson, Brandon Isaacson, Paul W Gidley, J Walter Kutz, Jamie J Van Gompel, George B Wanna, Shaan M Raza, Franco DeMonte, Samuel L Barnett, Michael J Link
OBJECTIVE: To analyze clinical outcomes after treatment of petroclival chondrosarcoma and to propose a novel staging system. STUDY DESIGN: Retrospective case review, 1995 to 2015. SETTING: Multicenter study. PATIENTS: Consecutive patients with histopathologically proven petroclival chondrosarcoma. INTERVENTION(S): Microsurgery, endoscopic endonasal surgery, radiation therapy, observation. MAIN OUTCOME MEASURES: Disease- and treatment-associated morbidity, recurrence, mortality...
August 2016: Otology & Neurotology
Roberto Altieri, Tetsuro Sameshima, Paolo Pacca, Emanuela Crobeddu, Diego Garbossa, Alessandro Ducati, Francesco Zenga
Petroclival meningiomas are a challenge for neurosurgeons due to the complex anatomy of the region that is rich of vessels and nerves. A perfect and detailed knowledge of the anatomy is very demanding in neurosurgery, especially in skull base surgery. The authors describe the microsurgical anatomy to perform an anterior petrosectomy based on their anatomical and surgical experience and perform a literature review. The temporal bone is the most complex and fascinating bone of skull base. The apex is located in the angle between the greater wing of the sphenoid and the occipital bone...
May 19, 2016: Neurosurgical Review
Kazuhide Adachi, Motoharu Hayakawa, Kohei Ishihara, Tukasa Ganaha, Shinya Nagahisa, Mituhiro Hasegawa, Yuichi Hirose
OBJECTIVE: To elucidate venous drainage patterns to avoid damage to the venous drainage route in the middle cranial fossa and superior petrosal sinus when employing the transpetrosal approach. METHODS: Venous drainage patterns were assessed using three-dimensional computed tomography venography in 22 hemispheres of petroclival meningioma (PCM) cases from patients who underwent primary surgery and 40 hemispheres of control cases. Intracranial venous drainage patterns were compared between control cases and PCM cases...
August 2016: World Neurosurgery
Matthew Miller, Monica S Pearl, Emily Wyse, Alessandro Olivi, Howard W Francis
Objectives To describe an enhanced infralabyrinthine approach to petroclival lesions with jugular bulb decompression, and to quantify surgical access using a flat-panel computed tomography image protocol. Design Retrospective case series and paired comparison of pre- versus post-dissection anatomy. Setting Tertiary academic medical center. Participants Four patients presenting with petroclival lesions. Six fresh cadaveric specimens were used for temporal bone dissection. Main Outcome Measures Axial and coronal dimensions, and access angles of the infralabyrinthine surgical corridor...
June 2016: Journal of Neurological Surgery. Part B, Skull Base
Thomas John Muelleman, Jeremy Peterson, Naweed Iffat Chowdhury, Jason Gorup, Paul Camarata, James Lin
Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure...
June 2016: Journal of Neurological Surgery. Part B, Skull Base
Osama Ahmed, Jonathan Walther, Krystle Theriot, Morganne Manuel, Bharat Guthikonda
Introduction The anterior petrosectomy is a well-defined skull base approach to lesions such as petroclival meningiomas, posterior circulation aneurysms, petrous apex lesions (chondrosarcomas, cholesteatomas), ventrolateral brainstem lesions, clival chordomas, trigeminal neurinomas, and access to cranial nerves III, IV, V, and VII. Methods and Materials Fourteen anterior petrosectomies on eight cadaveric heads were performed in a skull base dissection laboratory. Predissection and postdissection thin-cut computed tomography scans were obtained to compare the bone resection...
June 2016: Journal of Neurological Surgery. Part B, Skull Base
Eric Mason, Jason Van Rompaey, C Arturo Solares, Ramon Figueroa, Daniel Prevedello
Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity. Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region...
June 2016: Journal of Neurological Surgery. Part B, Skull Base
Zhou Xu, Xingruo Zeng, Daofeng Tian, Qianxue Chen
AIM: To study and summarize our experience with the subtemporal transtentorial approach for resection of petroclival tumors. MATERIAL AND METHODS: Twenty-eight patients who suffered from petroclival tumors and underwent tumor resection via a subtemporal transtentorial approach between October 2010 and July 2013 were retrospectively reviewed. RESULTS: Total resection was performed in 22 cases, at a rate of 78.57%, subtotal resection in 5 cases, and large portion resection in 1 case...
2016: Turkish Neurosurgery
Masanori Yoshino, Kumar Abhinav, Fang-Cheng Yeh, Sandip Panesar, David Fernandes, Sudhir Pathak, Paul A Gardner, Juan C Fernandez-Miranda
BACKGROUND: Recent studies have demonstrated diffusion tensor imaging tractography of cranial nerves (CNs). Spatial and angular resolution, however, is limited with this modality. A substantial improvement in image resolution can be achieved with high-angle diffusion magnetic resonance imaging and atlas-based fiber tracking to provide detailed trajectories of CNs. OBJECTIVE: To use high-definition fiber tractography to identify CNs in healthy subjects and patients with brain tumors...
July 2016: Neurosurgery
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