Article
Petroclival meningiomas: Which role plays the experience of the neurosurgeon for obtaining favourable results?
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Authors
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Veit Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen; Klinik für Neurochirurgie, RWTH Aachen
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Daniela Benders
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen
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Dorothee Mielke
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen
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Joachim M. Gilsbach
- Klinik für Neurochirurgie, RWTH Aachen
| Published: | June 2, 2015 |
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Outline
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Objective: Petroclival meningiomas represent a challenge for the neurosurgeon because of the close relationship between the tumor, the basilar artery and its branches and the cranial nerves (CN), and the often large size before coming to attention. It seems to be common sense that the surgical results improve with an increasing numbers of operated cases per neurosurgeon. It is the aim of the present study to investigate if this assumption holds true.
Method: 52 patients (41 women/ 11 men, mean age 55 years) underwent microsurgical removal of a petroclival meningioma under electrophysiological monitoring mainly by two neurosurgeons within 11 years. The clinical files of these patients were retrospectively reviewed with special focus on surgery-related complications. The complication rate in the first and the second half of the 11 years for each neurosurgeon was calculated.
Results: The most common preoperative symptoms were CN V dysfunction (hypesthesia) (n=14), followed by hypacusis (n=11) and unsteady gait (n=10). The by far most common approach was the standard retrosigmoid approach (n=18), followed by the anterosigmoid-temporal approach (n=7). In half of the patients (n=20), complete resection was not performed / not intended because of tumor spread into the cavernous sinus. The most common complications were new facial paresis in 8 patients (persisting in 5 patients; 10 %) and new diplopia in 11 patients (persisting in 9 patients; in 18 %), while new other permanent CN dysfunctions were only occasionally seen. Four brain stem infarctions occurred, leading to death in 1 (mortality rate 2.5 %) and severe morbidity in 3 patients. The rate of complications including brain stem infarction was equally distributed between the neurosurgeons and the two time periods.
Conclusions: After having obtained a certain level of expertise, a further increase of the numbers of petroclival meningioma operations does not contribute to improved surgical results. This finding suggests that tumor-related factors such as consistency, size, brain stem edema play a larger role for the outcome than a further growing expertise of an already experienced neurosurgeon.
