1,721,026 research outputs found
POSTERIOR PETROUS FACE MENINGIOMAS:AN ALGORITHM FOR SURGICAL MANAGEMENT.
No full textOtol Neurotol. 2007 Oct;28(7):942-50.
Posterior petrous face meningiomas: an algorithm for surgical management.
Sanna M, Bacciu A, Pasanisi E, Taibah A, Piazza P.
SourceGruppo Otologico, Piacenza-Rome, Italy. [email protected]
Abstract
OBJECTIVE: The objective of the present study was to report our surgical strategy in the management of 81 patients with posterior petrous face meningiomas.
STUDY DESIGN: Retrospective study.
SETTING: This study was conducted at a quaternary private otology and cranial base center.
PATIENTS: Of 139 patients with posterior fossa meningioma, 81 occurred on the posterior petrous face of the temporal bone and were the object of this study.
INTERVENTIONS: Thirty-one patients were approached by the enlarged translabyrinthine approach. The enlarged translabyrinthine approach with transapical extension Type II was performedin 29 patients. The combined retrosigmoid-retrolabyrinthine approach was chosen in 8 cases. The modified transcochlear approach Type A with permanent posterior transposition of the facial nerve (FN) was performed in 6 patients. Two patients underwent a retrolabyrinthine subtemporal transapical approach. One patient underwent a transpetrous middle cranial fossa approach. Four patients with intracanalicular meningiomas were operated on through the enlarged middle cranial fossa approach.
RESULTS: Total removal of the tumor (Simpson Grades I and II) was achieved in most patients (92.5%). The FN was anatomically preserved in 79 of the 81 (97.5%) patients. Five patients had less than 1 year follow-up, and 2 patients were lost to follow-up and were excluded in evaluation of the final FN outcome. At 1-year follow-up, 46 patients (63%) had Grade I to II, 19 (26%) had Grade III, 4 (5.4%) had Grade IV, 1 (1.3%) had Grade V, and 3 (4.1%) had Grade VI. Hearing-preserving surgery was attempted in 15 patients (18.5%) with preoperative serviceable hearing. Of these 15 patients, 11 had their hearing preserved at the same preoperative level, and 4 experienced postoperative deafness. Postoperatively, a new deficit of 1 or more of the lower cranial nerves was recorded in 3 patients. One patient experienced subcutaneous cerebrospinal fluid collection that required surgical management.
CONCLUSION: Total tumor removal (Simpson Grades I-II) remains our treatment of choice and takes priority over hearing preservation. Subtotal resection is indicated for older and debilitated patients with giant lesions to relieve the tumor compression on the cerebellum and brainstem. Subtotal removal is also preferred in the face of the absence of a plane of cleavage between the tumor and the brainstem, in the presence of encasement of vital neurovascular structures, in elderly patients with tumors adherent to preoperatively normal facial or lower cranial nerves
Surgical management of jugular foramen meningiomas: a series of 13 cases and review of the literature.
No full textOBJECTIVE:
Primary meningiomas occurring within the jugular foramen are exceedingly rare lesions presumed to originate from arachnoid-lining cells situated within the jugular foramen. The objective of this study is to analyze the management and outcome in a series of 13 primary jugular foramen meningiomas collected at a single center.
STUDY DESIGN:
Retrospective study.
SETTING:
Quaternary referral otology and skull base private center.
METHODS:
Charts belonging to 13 consecutive patients with pathologically confirmed jugular foramen meningioma surgically treated between September 1991 and May 2005 were examined retrospectively. The follow-up of the series ranged from 12 to 120 (mean, 42.8 +/- 27.5) months.
RESULTS:
Four (28.5%) patients underwent single-stage tumor removal through the petro-occipital transigmoid (POTS) approach. In two patients with preoperative unserviceable hearing, a combined POTS-translabyrinthine approach was adopted. Two patients underwent a combined POTS-transotic approach because of massive erosion of the carotid canal. A modified transcochlear approach type D with posterior rerouting of the facial nerve and transection of the sigmoid sinus and jugular bulb was performed in two patients with a huge cerebellopontine angle tumor component with extension to the prepontine cistern together with massive involvement of the petrous bone and middle ear and encasement of the vertical and horizontal segments of the intrapetrous carotid artery. In one patient with evidence of a dominant sinus on the site of the tumor, a subtotal tumor removal via an enlarged translabyrinthine approach (ETLA) was planned to resect the intradural component of the tumor. Two patients in our series underwent a planned staged procedure on account of a huge tumor component in the neck. One of these patients underwent a first-stage infratemporal fossa approach type A to remove the tumor component in the neck; the second-stage intradural removal of the tumor was accomplished via an ETLA. The last patient underwent a first-stage modified transcochlear type D approach to remove the intradural tumor component followed by a second-stage transcervical procedure for removal of the extracranial component. Gross total tumor removal (Simpson grade I-II) was achieved in 11 (84.6%) cases. Subtotal removal of the tumor was accomplished in two patients. Good facial nerve function (grades I and II) was achieved in 46.1% of cases, whereas acceptable function (grade III) was achieved in the remaining cases 1 year after tumor removal. Hearing was preserved at the preoperative level in all four patients who underwent surgery via the POTS approach. After surgery, no patient recovered function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 61.5% of cases.
CONCLUSIONS:
Surgical resection is the treatment of choice for jugular foramen meningiomas. Among the various surgical techniques proposed for dealing with these lesions, we prefer the POTS approach alone or combined with the translabyrinthine or transotic approaches. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge
Surgical Management of Jugular Foramen Meningiomas: A Series of 13 Cases and Review of the Literature.
No full textSurgical management of jugular foramen schwannomas with hearing and facial nerve function preservation: a series of 23 cases and review of the literature.
No full textOBJECTIVE:
Schwannomas of the jugular foramen are rare lesions and controversy regarding their management still exists. The objective of this retrospective study was to analyze the management and outcome in a series of 23 cases collected at a single center.
SETTING:
This study was conducted at a quaternary private otology and skull base center.
METHODS:
Charts belonging to patients with a diagnosis of jugular foramen schwannoma attending our center between May 1988 and April 2006 were examined retrospectively.
RESULTS:
The study group consisted of 23 patients. One patient (a 73-year-old woman) with normal lower cranial nerves function was managed with watchful expectancy and regular clinical and radiologic follow ups. The infratemporal fossa approach-type A (IFTA-A) was performed in 3 cases. One patient underwent a transcochlear-transjugular approach. Of the 22 patients surgically treated, 12 patients were operated on by the petrooccipital transsigmoid approach (POTS). In one patient with a preoperative dead ear, a combined POTS-translabyrinthine approach was adopted. Two patients were operated on through the POTS approach combined with the transotic approach. In another case (a 67-year-old woman), a subtotal tumor removal through a transcervical approach was planned to resect a 10-cm mass in the neck. One patient underwent a first-stage combined transcervical-subtotal petrosectomy approach to remove a huge tumor in the neck; the second-stage intradural removal of the tumor was accomplished through a translabyrinthine-transsigmoid-transjugular approach. The last patient underwent a first-stage combined transcervical-subtotal petrosectomy approach to remove the neck tumor component; this patient is now waiting for the second-stage intradural removal of the tumor. Complete tumor removal was accomplished in 21 cases and in one case, a residual schwannoma was left in place in the area of the jugular foramen. The 3 patients who were operated on by IFTA-A underwent permanent anterior transposition of the facial nerve. At 1-year follow up, 2 of these patients had House-Brackmann grade I and 1 reached grade IV. The patient who underwent a transcochlear-transjugular approach had a permanent posterior transposition of the facial nerve. At 1-year follow up, he had grade III facial nerve function. Postoperative facial nerve function was normal (House-Brackmann grade I) in all patients operated on by the POTS approach. Twelve patients had hearing-preserving surgery using the POTS approach. Good hearing was preserved in 10 cases (83.3%), the majority of whom (58.3%) maintained their preoperative hearing level. There was no perioperative mortality. One patient (4.5%) experienced a postoperative cerebrospinal fluid leak. After surgery, all patients did not recover the function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 50% of cases. So far, no patient has experienced recurrence during the follow-up period as ascertained by computed tomography or magnetic resonance imaging.
CONCLUSIONS:
Surgical resection is the treatment of choice for jugular foramen schwannomas. The POTS approach allowed single-stage, total tumor removal with preservation of the facial nerve and of the middle and inner ear functions in the majority of cases. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge
Anatomic relationships between surgical landmarks in type b and type c infratemporal fossa approaches.
No full textAnatomic relationships of the structures exposed in type B and C infratemporal fossa approaches were studied in 20 temporal bones. The intrapetrous carotid artery (ICA), cochlea (CH), eustachian tube (ET), foramen spinosum (FS), foramen ovale (FO) and anterior foramen lacerum (AFL) were exposed by drilling of the glenoid fossa and base of middle cranial fossa. The relationships of the ICA with the cochleariform process (CP), CH, ET, FS, FO and AFL were noted along with associated measurements. The CP was lodged at a mean distance of 9.2 mm from the ICA genu. The ET was found to intersect the ICA. The mean distance of the ICA to the CH was 1.6 mm. The carotid canal was dehiscent on its horizontal portion in 30% of the bones studied and on its vertical portion in 5%. The periarterial venous plexus was found in 70% of the bones. No obvious branch was observed emerging from the vertical portion of the ICA. The FS was found to be a canal having a mean length of 5.8 mm
Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases.
No full textOBJECTIVE:
To determine the incidence rate of cerebrospinal fluid (CSF) leak after translabyrinthine vestibular schwannoma surgery since the alteration of the surgical procedure. To compare with previous series and other series in literature.
STUDY DESIGN:
Database analysis.
SETTING:
Tertiary referral neurotologic private practice.
PATIENTS:
A series of 1,803 patients who underwent translabyrinthine vestibular schwannoma surgery between 1993 and 2009. The result of this group was compared with corresponding series.
INTERVENTION:
Translabyrinthine and extended translabyrinthine vestibular schwannoma surgery. Literature review and comparison.
MAIN OUTCOME MEASURES:
Rates of CSF leak in this series and historical perspective of the outcome.
RESULTS:
Fifteen patients (0.8%) of 1,803 cases had CSF leaks. The method used since 1993 has shown a significant improvement compared with major case series of the last 10 years.
CONCLUSION:
The methods used in translabyrinthine vestibular schwannoma surgery in our center can reduce CSF leakage to an absolute minimum. Compared with all large series, this could be a new era of translabyrinthine vestibular schwannoma surgery
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