Meningiomas of the upper and middle part of the clivus and surrounding structures: early and long-term outcome.

BACKGROUND AND PURPOSE: Meningiomas of the upper and middle parts of the clivus and surrounding structures are removed using petrosal approaches: anterior, posterior, combined and complete. The purpose of this study is to show the results of treatment of these meningiomas and to present our interpretation of the treatment strategy. MATERIAL AND METHODS: Twenty-six patients (17 women, 9 men) were included in the study. The neurological status of the patients was assessed before and after surgery as well as at the conclusion of the treatment. The following measurements and data were collected and recorded: approximate volume of the treated lesion, its relation to large blood vessels, cranial nerves and the brainstem, as well as tumour consistency and vascularisation. RESULTS: Symptoms duration ranged from 1 to 60 months (median: 16 months). In 57.7% of patients, imbalance was the predominant sign. Less frequent symptoms were: head-aches, dysacusis and hemiparesis. Approximate volumes of the tumours ranged from 4 to 65 mL (mean: 32 mL). Total or subtotal resection was achieved in 73.1% of patients. The patients' performance improved postoperatively in 34.5%, remained unchanged in 46.2% and deteriorated in 11.5% of patients. Two (7.8%) patients died after the surgery. CONCLUSIONS: The use of petrosal approaches in the surgical treatment of meningiomas of the upper and middle parts of the clivus and the surrounding structures facilitates good or at least satisfactory neurological outcome with a high proportion of complete resections and relatively low mortality.

[Anterior petrosal approach - analysis of the surgical technique in cadavers simulation]. / Dostep skalisty przedni - analiza techniki operacyjnej na podstawie symulacji na zwlokach.

The aim of the study was to present consecutive stages of the anterior petrosal approach (APA). Eight simulations of APA were performed on non-fixed human cadavers without any known pathologies of the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for APA is a temporal craniotomy and extradural exposition of the base of the middle cranial fossa. Mobilisation of the trigeminal nerve allows for removal of the apex of the petrous bone. Approach to the upper part of the clivus is achieved by elevation of the temporal lobe and section of the tentorium and superior petrosal sinus with surrounding dura. Anterior petrosal approach is a reproducible technique, which provides surgical penetration of the upper clivus and related regions. This approach is particularly useful in the treatment of tumors of the mentioned above anatomical areas.

[Posterior petrosal approach - analysis of the surgical technique in cadavers simulation]. / Dostep skalisty tylny - analiza techniki operacyjnej na podstawie symulacji na zwlokach.

The aim of the study was to present consecutive stages of the posterior petrosal approach (PPA). Eighteen simulations of PPA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for PPA is a temporal craniotomy, suboccipital craniectomy and mastoidectomy with keeping the bony labyrinth intact. Approach to the middle part of the clivus is achieved by raise of the temporal lobe and section of the superior petrosal sinus and tentorium and by mobilization the sigmoid sinus. Posterior petrosal approach is a reproducible technique, which provides surgical penetration of the middle clivus and related regions. It reduces the operating distance and allows to limit the cerebellum and temporal lobe traction and to preserve the anatomic integrity of the brain stem and cranial nerves of the cerebellopontine angle.

Surgical treatment of the tentorial and falco-tentorial junction meningiomas.

INTRODUCTION: Tentorial meningiomas account for 3-7.7% of all meningiomas in surgically treated patients. In this group, the falco-tentorial meningiomas are considered to be the rarest. CASE REPORT: The paper presents three cases of the tentorial and falco-tentorial junction meningiomas. Two of the meningiomas were of major size and with an attachment at the falco-tentorial junction, while the other was attached to the inferior notch of the tentorium. The lesions manifested as headaches and disequilibrium that persisted for many years. The Parinaud syndrome and diplopia were observed in the patient with the meningioma attachment at the inferior notch of the tentorium. One of the lesions was resected completely using an occipital bitranstentorial/falcine approach. In the second case an occipito-transtentorial approach was used. However, during the surgery problems arose with resecting the lesion on the other side. The meningioma of the inferior notch of the tentorium was vascularized through the tentorial artery stemming from the meningo-hypophyseal trunk of the intracavitary section of the internal carotid artery on the right side. This meningioma required a two-stage operation. The surgical treatment was satisfactory and depended on the patient's condition at the time of the surgery. CONCLUSION: The presented rare cases of tentorial and falco-tentorial junction meningiomas seem to suggest that their treatment should be surgical and launched promptly after making a diagnosis. The results of the treatment might then be favourable.