PMID- 34404178
OWN - NLM
STAT- Publisher
LR  - 20240220
IS  - 0529-5815 (Print)
IS  - 0529-5815 (Linking)
VI  - 59
IP  - 9
DP  - 2021 Sep 1
TI  - [Evaluation of classification of petroclival meningiomas and proposed selection 
      of microsurgical approach: a single center experience of 179 cases].
PG  - 785-792
LID - 10.3760/cma.j.cn112139-20210511-00212 [doi]
AB  - Objective: To evaluate the classification of petroclival meningiomas(PCM), 
      proposed selection of microsurgical approach and therapeutic outcomes. Methods: 
      Retrospectively analyzed clinical data of 179 cases of PCM from Department of 
      Neurosurgery, Xiangya Hospital, Central South University between January 2011 and 
      November 2020. There were 28 males and 151 females with an age of(49.9+/-10.2) 
      years(range: 22 to 75 years) and the tumor size of(44.8+/-10.3)mm(range: 15 to 80 
      mm). The mean duration of symptom(M(Q(R))) was 18.0(40.6)months(range:1 week to 
      320 months) and the mean preoperative Karnofsky performance scale(KPS) was 
      78.6+/-13.3(range: 40 to 100). The PCM were classified into 5 types according to 
      the difference in the origin of dural attachment, involvement of adjacent 
      structures and growth patterns through preoperative MRI. The surgical approaches 
      were selected based on the proposed classification, and the clinical 
      characteristics, surgical record, and follow-up data of each type were reviewed. 
      Results: The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 
      60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 
      2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 
      cases were obtained microsurgical treatment except CSB type. The gross total 
      resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid 
      approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 
      cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 
      cases of extended pterional transtentorial approach(EPTA) and presigmoid combined 
      supra-infratentorial approach, respectively. The RSA could be adopted in both of 
      CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ 
      were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two 
      cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve 
      paralysis. The postoperative morbidity and complications were recovered or 
      improved with conservative and positive symptomatic and supportive treatment. 
      There was no intraoperative and postoperative death case. One hundred and sixty 
      four cases(93.2%) of operative patients were followed with the duration of 
      24(48)months(range:3 to 108 months). Tumor recurrence and progress were 
      identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with 
      postoperative neurological status, 89 patients(54.3%) had improved and 38 
      patients(23.2%) were still suffering various degrees of neurological dysfunctions 
      during the follow-up. The recent KPS was 84.2+/-11.4(range: 50 to 100) without 
      statistical difference from preoperative KPS(t=-1.356,P=0.125). As for each type, 
      there were statistically significant differences in brain stem 
      edema(chi(2)=3.482,P=0.038), gross total resection(chi(2)=9.127,P=0.001), surgical 
      duration(F=8.954, P=0.013), postoperative length of stay(F=3.652, P=0.025), 
      postoperative complications(chi(2)=1.550,P=0.024), postoperative KPS(F=2.856, 
      P=0.042) and tumor recurrence/progress(chi(2)=4.824,P=0.013). Conclusion: The 
      precise and comprehensive classification of PCM and specific individual treatment 
      strategy are benefit to evaluate the diverse clinical prognosis, choose optimal 
      surgical approaches, elevate gross total resection, diminish neurological 
      dysfunctions and restraint tumor recurrence, so as to improve the quality of life 
      for patients.
FAU - Zhao, Z J
AU  - Zhao ZJ
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Yuan, X R
AU  - Yuan XR
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Yuan, J
AU  - Yuan J
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Xie, Y Y
AU  - Xie YY
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Tang, C
AU  - Tang C
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Li, H Y
AU  - Li HY
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Zhang, G D
AU  - Zhang GD
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Jiang, W X
AU  - Jiang WX
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
FAU - Liu, Q
AU  - Liu Q
AD  - Department of Neurosurgery, Xiangya Hospital, Central South University, 
      Neurosurgical Medical Central, Central South University, Clinical Research Center 
      for Skull Base Surgery and Neurooncology in Hunan Province, Changsha 410008, 
      China.
LA  - chi
PT  - English Abstract
PT  - Journal Article
DEP - 20210901
PL  - China
TA  - Zhonghua Wai Ke Za Zhi
JT  - Zhonghua wai ke za zhi [Chinese journal of surgery]
JID - 0153611
SB  - IM
EDAT- 2021/08/19 06:00
MHDA- 2021/08/19 06:00
CRDT- 2021/08/18 03:39
PHST- 2021/08/18 03:39 [entrez]
PHST- 2021/08/19 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
AID - 10.3760/cma.j.cn112139-20210511-00212 [doi]
PST - aheadofprint
SO  - Zhonghua Wai Ke Za Zhi. 2021 Sep 1;59(9):785-792. doi: 
      10.3760/cma.j.cn112139-20210511-00212.