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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
[Natural history and surgical results of petroclival meningiomas]
Shunsuke Terasaka1, Katsuyuki Asaoka, Hiroyuki Kobayashi
1Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
Abstract:
Our therapeutic strategy for the petroclival meningioma (PCM) allows for observation for asymptomatic and microsurgery for symptomatic cases. For evaluation of this strategy, functional status assessed by the Karnofsky Performance Score (KPS) in each group was retrospectively analyzed. The records of 29 patients with PCMs were reviewed. Fifteen patients were enrolled in the observation group and the median follow-up period was 40 months (range, 5-170). Eighteen patients underwent operative procedures for resection of PCMs and the median follow-up period was 65.5 months (range, 9-194). In the observation group, 60% of the cases showed radiological tumor growth during the follow-up period. There was functional deterioration in 47% of the cases. The growing tumors were unpredictable. In the microsurgery group, gross tumor resection was accomplished in 22% of the cases. The surgical morbidity rate, a KPS less than 80, at three months after surgery and at the time of the last follow-up was 56% and 6%, respectively. Postoperative KPS at three months after surgery was significantly worse than preoperative KPS. However, most of the patients with a worse KPS had recovered at the time of the last follow-up and they had a favorable functional outcome. Regarding the degree of the KPS change, there was no significant difference between the observation and the microsurgery groups during the follow-up periods. Based on the functional outcomes of each group, our therapeutic strategy for PCMs was shown to be reasonable and warranted.
Insights
Observation and microsurgery are reasonable strategies for petroclival meningiomas (PCMs). While observation shows tumor growth, microsurgery offers resection, with most patients achieving favorable functional outcomes (Karnofsky Performance Score) long-term.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Context:
- Petroclival meningiomas (PCMs) present unique therapeutic challenges.
- A dual strategy of observation for asymptomatic cases and microsurgery for symptomatic cases is employed.
- Evaluating the long-term functional outcomes of this therapeutic approach is crucial.
Purpose:
- To retrospectively analyze the functional status of patients with petroclival meningiomas (PCMs) undergoing observation versus microsurgery.
- To assess the efficacy and safety of a therapeutic strategy for PCMs based on patient functional outcomes.
Summary:
- The study reviewed 29 petroclival meningioma (PCM) patients: 15 observed and 18 treated with microsurgery.
- Observation group: 60% showed tumor growth, 47% experienced functional decline.
- Microsurgery group: 22% gross tumor resection, initial functional decline (KPS < 80) in 56% at 3 months, improving to 6% at last follow-up.
Impact:
- The therapeutic strategy for petroclival meningiomas (PCMs) is deemed reasonable and warranted.
- Findings suggest that while microsurgery can lead to initial functional deficits, long-term outcomes are generally favorable.
- No significant difference in Karnofsky Performance Score (KPS) change between groups indicates comparable long-term functional trajectories.
