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The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area.

Lim J, Cho K - J. Neurooncol. (2016)

Bottom Line: In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach.There was no significant difference in the gross total resection rate between the two approaches (p = 0.67).The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Yatap-dong 59, Seongnam, 463-712, Korea.

ABSTRACT
Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.

No MeSH data available.


Related in: MedlinePlus

a and e Preoperative MR images of petroclival meningioma in a 45-year-old female patient who underwent ventriculoperitoneal shunt placement before tumor removal. b and f Immediate postoperative MR images show that the tumor was totally removed via the MLSO approach. c and g MR images show no recurrence of tumor 6 months after surgery. d The petroclival junction lesion and the tumor. h The basilar artery (black arrow head) was freely exposed after tumor resection
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Fig3: a and e Preoperative MR images of petroclival meningioma in a 45-year-old female patient who underwent ventriculoperitoneal shunt placement before tumor removal. b and f Immediate postoperative MR images show that the tumor was totally removed via the MLSO approach. c and g MR images show no recurrence of tumor 6 months after surgery. d The petroclival junction lesion and the tumor. h The basilar artery (black arrow head) was freely exposed after tumor resection

Mentions: A total of 50 patients with meningioma or trigeminal schwannoma in the PCJ and ACP area were included in the analysis. The mean age was 46.5 years, and 13 patients were male and 37 were female. The tumor volume of patients undergoing the combined petrosal approach and MLSO approach was 33.46 ± 17.0 cm3 and 32.79 ± 24.9 cm3, respectively, with no significant difference between the two groups (p = 0.925). More than 60 % of tumors were located in the anterior CPA for both approaches (Table 1). Major symptoms included headache, dizziness, facial hypoesthesia, and gait disturbance. Twenty-seven patients underwent operation by the combined petrosal approach, among whom 12 had meningioma and 15 had trigeminal schwannoma. Twenty-three patients underwent operation by the MLSO approach, nine with meningioma and 14 with trigeminal schwannoma (Table 1). Representative preoperative and postoperative MR images of meningioma and schwannoma are provided in Figs. 3 and 4.Table 1


The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area.

Lim J, Cho K - J. Neurooncol. (2016)

a and e Preoperative MR images of petroclival meningioma in a 45-year-old female patient who underwent ventriculoperitoneal shunt placement before tumor removal. b and f Immediate postoperative MR images show that the tumor was totally removed via the MLSO approach. c and g MR images show no recurrence of tumor 6 months after surgery. d The petroclival junction lesion and the tumor. h The basilar artery (black arrow head) was freely exposed after tumor resection
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4835518&req=5

Fig3: a and e Preoperative MR images of petroclival meningioma in a 45-year-old female patient who underwent ventriculoperitoneal shunt placement before tumor removal. b and f Immediate postoperative MR images show that the tumor was totally removed via the MLSO approach. c and g MR images show no recurrence of tumor 6 months after surgery. d The petroclival junction lesion and the tumor. h The basilar artery (black arrow head) was freely exposed after tumor resection
Mentions: A total of 50 patients with meningioma or trigeminal schwannoma in the PCJ and ACP area were included in the analysis. The mean age was 46.5 years, and 13 patients were male and 37 were female. The tumor volume of patients undergoing the combined petrosal approach and MLSO approach was 33.46 ± 17.0 cm3 and 32.79 ± 24.9 cm3, respectively, with no significant difference between the two groups (p = 0.925). More than 60 % of tumors were located in the anterior CPA for both approaches (Table 1). Major symptoms included headache, dizziness, facial hypoesthesia, and gait disturbance. Twenty-seven patients underwent operation by the combined petrosal approach, among whom 12 had meningioma and 15 had trigeminal schwannoma. Twenty-three patients underwent operation by the MLSO approach, nine with meningioma and 14 with trigeminal schwannoma (Table 1). Representative preoperative and postoperative MR images of meningioma and schwannoma are provided in Figs. 3 and 4.Table 1

Bottom Line: In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach.There was no significant difference in the gross total resection rate between the two approaches (p = 0.67).The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Yatap-dong 59, Seongnam, 463-712, Korea.

ABSTRACT
Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.

No MeSH data available.


Related in: MedlinePlus