Artikel
Surgery of recurrent petroclivaler meningiomas – do the results justify repeated surgeries?
Resektion rezidivierender pertoclivaler Meningeome – Berechtigen die Ergebnisse eine wiederholte Operation?
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Autoren
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Gabriele Schackert
- Technische Universität Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Tareq Juratli
- Technische Universität Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Surgery of petroclival meningiomas (PCM) is challenging and is associated with high morbidity and mortality due to tumor localization. The question arises, whether repeated surgery of these difficult tumors is indicated with particular emphasis on postoperative neurological deficits and quality of life for the patients.
Methods: In a retrospective study, we evaluated the outcome of 25 patients with recurrent PCMs who underwent repeated surgery. We compared these results with 123 primarily PCMs, resected in our institution.
Results: 24 of 25 patients were available for long-term follow-up. The median age was 60.4 years. The gender distribution m: f was 1:3. Twenty patients underwent one, four two and one patient three surgeries upon tumor recurrence. The cranial approaches were subtemporal/pterional (n=14), suboccipital retrosigmoid (n=10), and combined in one case. The median tumor size amounted to 16.6 ccm. In 22 patients the tumor removal was subtotal, whereas in 5 patients gross total resection was achievable. The histology revealed in 6 cases a malignant transformation of the primarily removed meningioma (4 WHO grade II and 2 WHO grade III). The overall neurological results showed in three patients (12.5%) deterioration of the neurological functions, while 18 patients demonstrated a KPS > 70. When comparing these results with the 123 primarily operated patients, it was obvious that the completeness of resection (72/123, p= 0.0007) was significantly more favorable and higher-grade tumors were less common (13/106, p= 0.09) in the group with primarily PCM. However, the functional neurological deterioration with 22.3% was higher in the primary group than in the recurrent group.
Conclusion: Repeated surgery of petroclival meningiomas is indicated. The risk for neurological deficits is not higher than after primary surgeries. Since gross total resection might not be possible in most of the cases, adjuvant radiotherapy should be discussed after maximal tumor volume reduction.
