Artikel
Surgery Versus Radiosurgery for Small Petroclival Meningiomas
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Autoren
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Guilherme Montibeller
- Neurological Institute of Curitiba, Curitiba, Brazil
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Mauricio Coelho Neto
- Neurological Institute of Curitiba, Curitiba, Brazil
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Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba, Brazil
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Treatment of large petroclival meningiomas (PCM) causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of patients with small, often asymptomatic PCM is controversial and includes observation, microsurgery and radiosurgery. The natural history of these tumors is not well known. The purpose of this retrospective study was to compare the outcome and extent of removal of small PCMs (< or =3 cm) with series of PCMs treated with radiosurgery.
Methods: This study comprised 29 patients with small (< or =3 cm) tumors from a total series of 107 consecutive patients with PCMs who underwent surgical removal. The mean age of patients was 56.8 years. Tumor removal was classified as radical (Simpson's grade I/II) and non-radical (Simpson's grade III/IV. The most frequent symptoms at presentation were: headaches (n = 20), tinnitus (n = 11), diplopia (n = 9) and facial hypoaesthesia (n = 7). The surgical approaches were: retrosigmoid (n =24), fronto lateral (n =3) and presigmoid (n =2). The postoperative follow-up ranged from 4 to 130 months. A review of outcome of PCMs series treated by radiosurgery was performed and compared with our surgical results.
Results: Radical tumor resection was achieved in 28 patients (96%). In one case a Simpson’s grade III resection was achieved due to trigeminal nerve infiltration and encasement of the superior cerebellar artery. Postoperative transient abducens nerve palsy occurred in five cases and two patients presented transient facial palsy. These deficits recovered completely in a short follow-up period. There was no mortality. The preoperative cranial nerves deficits improved after surgery. Only one patient remained with diplopia.
Conclusion: Larger PCMs present poorer outcomes after surgical removal than small ones. Radiosurgery is indicated to treat small PCMs. Results of patients treated by radiosurgery should be compared with surgical series that include only small tumors. Radical removal of small PCMs can be achieved with minimal morbidity and may result in cure of patient. The results achieved in this surgical series are superior than with radiosurgery.
