gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Surgical strategies for petroclival meningioma and evaluation of prognostic factors influencing clinical outcome

Chirurgische Strategien zur Behandlung von petroclivale Meningiom und Auswertung prognostischer Faktoren, die das klinische Ergebnis beeinflussen

Meeting Abstract

  • presenting/speaker Waseem Masalha - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Dieter Henrik Heiland - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Oliver Schnell - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Jürgen Grauvogel - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV188

doi: 10.3205/21dgnc183, urn:nbn:de:0183-21dgnc1832

Veröffentlicht: 4. Juni 2021

© 2021 Masalha et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Despite the advances in skull base surgery, surgical removal of petroclival meningioma (PCM) remains a major neurosurgical challenge in terms of postoperative neurological morbidity and long-term oncological outcome. To date, there are still controversial surgical strategic treatment concepts and limited knowledge about adjuvant radiotherapy, prognostic factors and their influence on the course of the disease.

Methods: The purpose of this study was to evaluate prognostic factors influencing the progression-free survival (PFS) rates of petroclival meningiomas, with a particular focus on the role of the extent of resection and postoperative adjuvant radiotherapy.

Results: Between 1998 and 2018, 89 patients with petroclival meningiomas were treated in our Department of Neurosurgery, of whom 19 patients underwent gross total resection (GTR) and 70 patients underwent subtotal resection (STR). Thirty-one patients received postoperative adjuvant radiotherapy of the residual tumour and fifty-eight were treated with surgery alone. Gross total resection (Simpson Grades I and II) was associated with significantly improved PFS (hazard ratio = 4, CI (95%) 1.3–12, p-value = 0.0107). Adjuvant radiotherapy showed an improvement in PFS (hazard ratio = 2.9, CI (95%) 1.1–7.1, p-value = 0.014). Even the subgroup analysis of extended PCM with infiltration of the cavernous sinus showed an advantage for PFS after GTR of the posterior fossa, i.e. near total resection (NTR). (Hazard ratio = 3.9 , CI (95%) 1.7–9.2, p-value = 0.0017). The additional radiotherapy of the residual tumour in the cavernous sinus in this subgroup also showed a beneficial effect on PFS (hazard ratio = 3.1, CI (95%) 1.2–7.9, p-value = 0.012).

Conclusion: Safely maximising the extent of resection for petroclival meningiomas correlates with a better outcome. Until now, the extension of surgical resection is still the most important prognostic factor in relation to oncological outcome. However, gross total resection of extended petroclival meningioma with infiltration of the cavernous sinus is associated with significant neurological morbidity and requires additional adjuvant therapy concepts.