J Korean Neurosurg Soc.  2019 Sep;62(5):610-617. 10.3340/jkns.2018.0015.

Intradural Transpetrosectomy for Petrous Apex Meningiomas

• Han S
• Zhang XH
• Han DH
• Jin YC

• KMID: 2457952
• DOI: http://doi.org/10.3340/jkns.2018.0015

Abstract

OBJECTIVE
This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve.
METHODS
The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications.
RESULTS
Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6-66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation.
CONCLUSION
PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.

Keyword

Meningioma; Petrous bone; Neurosurgical procedures

MeSH Terms

Brain Stem
Cavernous Sinus
Follow-Up Studies
Humans
Karnofsky Performance Status
Meningioma*
Mortality
Neurosurgical Procedures
Petrous Bone
Postoperative Complications
Quality of Life
Recurrence
Retrospective Studies
Survival Rate
Telephone
Veins

Figure

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  Fig. 1. A : Preoperative MRI, axial view : an enhanced petrous apex meningioma was seen around the right Meckel’s cave and extend into the supratentorial region. B : Preoperative CT : relationship between bone and tumor. C : Preoperative 3D-CT angiography : right posterior cerebral artery was compressed and replaced superior to the tumor. D : Postoperative MRI : no residual tumor. E : Postoperative CT : the drilling extent of petrous bone. F : Postoperative 3D-CT reconstruction : bone flap was placed back. MRI : magnetic resonance imaging, CT : computed tomography.

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  Fig. 2. A : Patient’s position and skin incision. B : The size of bone flap. C : Superior petrosal sinus groove was clipped with titanium clips. D : Identified the internal auditory canal by Garcia-Ibanz method [5]. E : Drilling extent. ① 1.5 cm : from the trigeminal nerve pressure trace to the internal auditory canal; ② 1.0 cm : from the petrous edge to the petrous section of internal carotid artery; ③ 1.0 cm : from the petrous tip to the petrosal sinus. F : Separated neurovascular structures from tumor. FS : foramen spinosum, GSPN : greater superficial petrosal nerve, AE : arcuate eminence, IAC : internal auditory canal, Gr. : great, For. : foramen, Trig. : trigminal, Pet. : petrosal, N. : nerve, Occip. : occipital, Arc. : arcuate, Emin. : eminece, Int. : internal, Ac. : arcuate, Sig. : sigmoid.

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  Fig. 3. Histological examination of meningioma following hematoxylin and eosin staining (×200).

Reference

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