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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Grade zero removal of supratentorial convexity meningiomas
T Kinjo1, O al-Mefty, I Kanaan
1Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
Abstract:
Although meningiomas are benign intracranial tumors, their frequency of recurrence after surgery has not been as low as expected. The recurrence rate of meningiomas is clearly related to the degree of tumor removal. Simpson Grade I removal, which entails excising the tumor and its dural and sinus attachments, is associated with the lowest rate of recurrence. To further minimize the recurrence of convexity meningiomas, we removed an additional dural margin of about 2 cm around the tumor (Grade 0 removal). For tumors involving bone, we removed the hyperostotic bone with a healthy margin and pericranium in en bloc resection. Between 1982 and 1992, 37 patients (15 men, 22 women) with an average age of 52.1 years were operated on by the above technique. Nineteen had a follow-up period of more than 5 years. To date, no tumors have recurred and no morbid incidences have occurred with this maneuver. We believe that the recurrence rate of convexity meningiomas can be diminished by including in the resection a margin of dura that might harbor a foci of tumor cells.
Insights
To reduce meningioma recurrence, a novel surgical technique (Grade 0 removal) was developed. This method, involving wider dural resection, resulted in zero recurrences in a 5-year follow-up study.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Meningiomas, though typically benign intracranial tumors, exhibit higher recurrence rates than anticipated.
- Tumor recurrence is strongly correlated with the extent of surgical resection, with Simpson Grade I removal showing the lowest rates.
Purpose of the Study:
- To investigate the efficacy of an extended dural resection (Grade 0 removal) in minimizing recurrence of convexity meningiomas.
- To assess the safety and effectiveness of this technique in patients with bone involvement.
Main Methods:
- A modified Simpson Grade I resection, termed Grade 0 removal, was employed, involving excision of a 2 cm dural margin around convexity meningiomas.
- For tumors with hyperostosis, en bloc resection of affected bone and pericranium was performed.
- Thirty-seven patients underwent surgery between 1982 and 1992, with 19 followed for over 5 years.
Main Results:
- No meningioma recurrences were observed in the 19 patients with over 5 years of follow-up.
- No significant morbid incidences were reported following the Grade 0 removal procedure.
- The technique was successfully applied to convexity meningiomas, including those involving bone.
Conclusions:
- Grade 0 removal, incorporating an extended dural margin, significantly reduces the recurrence rate of convexity meningiomas.
- This extended resection technique is a safe and effective method for managing convexity meningiomas, potentially preventing recurrence by addressing microscopic tumor foci in the dura.
