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Gerardo Guinto et al.
of the Department of Neurosurgery at Autónoma de México, National University of Mexico City, Mexico, conducted a clinical study to propose a simple method
to evaluate the applicability of RSA in resection of PCM based on the tumor characteristics of the posterior cranial fossa and the degree of displacement of the cerebellum, mid-foot and hemisphere.
The article was published in the September 2021 issue of the journal
Operative Neurosurgery.
- Excerpted from the article chapter
【Ref: Guinto G, et al.
Oper Neurosurg (Hagerstown).
2021 Sep 15; 21(4):225-234.
doi: 10.
1093/ons/opab224.
】
Research background
Petrooblique meningiomas (PCMs), adjacent to the brainstem, are one of
the most difficult tumors to remove in skull base surgery.
A number of surgical approaches have been used to remove PCM, the common being the transskeletal preskeletal approach, the retroskeletal approach, and the retrosigmoid sinus approach (RSA).
RSA is the appropriate surgical route and can provide an adequate area
of surgical exposure.
Skull base surgeons have attempted to propose the basis for choosing a surgical approach, however, these bases vary widely
due to the variable biological behavior of PCM and the surgeon's preference.
Gerardo Guinto of the Department of Neurosurgery of Autónoma de México, National University of Mexico City, Mexico, et al.
conducted a clinical study to propose a simple method
to evaluate the applicability of RSA in resection of PCM based on the tumor characteristics of the posterior cranial fossa and the degree of displacement of the cerebellar midfoot (MCP) and hemisphere.
The article was published in the September 2021 issue of the journal
Operative Neurosurgery.
Research methods
by pulling the cerebellum backwards.
This pulling process can be seen as a rotation
with the pontine brain as the center of the circle, the cerebellum in the foot and the hemisphere as the radius.
If PCM pushes the brainstem contralateral on the anterolateral pontine side, it is unlikely that RSA will adequately expose the MCP (Figure 1).
If the tumor is lateral or posterolateral to pontine, it can be fully exposed by RSA (Figure 2).
Figure 1.
A.
The tumor is located anterolateral to the pontine brain
.
B.
Displacement of the cerebellum/midcerebellar foot via the retrosigmoid sinus approach
.
C.
The microscope beam (yellow) only hits a small part of
the tumor.
Figure 2.
A.
The tumor is located on the lateral side
of the pontine brain.
B.
Displacement of the cerebellum/midcerebellar foot via the retrosigmoid sinus approach
.
C.
Microscopic light covers most of
the tumor.
The study prospectively included 20 patients with PCM, and the patients with MCP located on the lateral posterior side of the pontine brain were group A according to imaging, 15 patients; Patients with MCP located anterolateral pontine were group B, 5 patients
.
Study results
The results of the operation showed that 12 (80%) patients in group A had complete tumor resection, and the patients could restore their quality of life
after surgery.
Only 1 (20%) patient in group B had complete tumor resection
.
Conclusion of the study
In summary, the results of this study show that it is important
to judge the surgical approach through the position relationship between PCM and pontine brain indicated by imaging.
MCP is located on the lateral or posterolateral side of the pontine brain, and RSA is more appropriate
.
The outcome analysis may have been biased due to the small sample size, the fact that it came from a single centre, and that all tumours were performed by the same surgical group; Multicentre studies are needed to draw reliable conclusions
.
