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Posterior fossa meningiomas: surgical experience in 52 cases
S A Cudlip1, P R Wilkins, F G Johnston
1Department of Neurosurgery, St George's Hospital Medical School, Atkinson Morley's Hospital, London.
Background:
Early reports of the surgical management of posterior cranial fossa meningiomas (PCFM) yielded poor results with high rates of mortality and morbidity. With the advent of modern neuroimaging and microsurgical techniques the results of surgery have improved markedly, but despite these advances removal of these lesions remains a challenge.
Methods:
The results of the surgical treatment of PCF meningiomas were examined with the aim to identify particular features associated with increased mortality and morbidity.
Results:
Of 713 patients with meningioma, 52 patients were identified with PCFM. Total macroscopic excision was achieved in 44 patients (84%). Postoperative complications occurred in 28 patients (54%) with permanent sequelae in 18 (35%). There were no mortalities in the immediate postoperative period. Follow-up ranged from 14 to 174 months (mean 42), tumour has recurred in 11 patients (21%) with a long-term mortality of 11%. At their latest follow-up 41 (79%) of patients achieved Glasgow outcome scores of 4 or 5.
Conclusions:
Total excision of tumour should remain the goal of treatment in patients with PCFM. Despite the recent advances in preoperative planning and surgical techniques, the morbidity associated with surgery remains significant. Notwithstanding, the majority of patients achieve a good outcome with surgical treatment.
Insights
Surgical removal of posterior fossa meningiomas (PCFM) is challenging but achievable. While complications are common, most patients achieve good long-term outcomes with total tumor excision.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Posterior cranial fossa meningiomas (PCFM) historically had high mortality and morbidity.
- Modern neuroimaging and microsurgery have improved outcomes but PCFM removal remains challenging.
Purpose of the Study:
- To examine surgical treatment outcomes for PCFM.
- To identify factors associated with increased mortality and morbidity.
Main Methods:
- Retrospective review of 52 patients with PCFM.
- Analysis of surgical outcomes, complications, and long-term follow-up.
Main Results:
- Total macroscopic excision achieved in 84% of patients.
- 54% experienced postoperative complications, 35% with permanent sequelae.
- No immediate postoperative mortality; 11% long-term mortality.
- 79% achieved good Glasgow outcome scores (4 or 5) at follow-up.
Conclusions:
- Total tumor excision should be the primary goal for PCFM treatment.
- Significant morbidity persists despite surgical advances.
- The majority of patients experience good outcomes after surgical intervention.