NeoplasmPosterior fossa meningiomas: surgical experience in 161 cases
Section snippets
Methods and material
A total of 161 consecutive patients with PFM were operated on by the senior authors (L.N.S. and D.C.W.) at The George Washington University Medical Center, Washington D.C. over a period of 6 years, from April 1993 to April 1999. The retrospective analysis of these cases forms the subject of this report. All clinical, neuroradiological, surgical, and follow-up data for these patients were retrieved from our computerized database.
Patient population and clinical preoperative features
Thirty-three patients (20.5%) were male and 128 patients (79.5%) were female (ratio of 1:3.8). The ages of the patients in this study ranged from 10 to 81 years (mean = 47 years); their presenting symptoms and signs on admission are summarized in Table 1. Six patients were affected by neurofibromatosis type II, three patients had multiple brain meningiomas and one patient had a contralateral vestibular schwannoma. Head pain (50% of the patients) and disturbance of gait (44% of the patients)
Results
In this series the degree of operative tumor excision has been evaluated in terms of gross total, subtotal, and partial resection, as previously proposed [49]. This evaluation was primarily made based on postoperative MRI images but also supported by the surgeon’s impression at surgery (in patients with gross total excision). Gross total resection was obtained when residual tumor was not found on the MR images, and the surgeon also felt the resection was complete. If more than 90% of the tumor
Surgical complications
In this series there were no intraoperative deaths. Death occurred in four patients and the peri-operative mortality rate was 2.5%. Among them one patient was from group IV, one from group III and two from group V. One patient who had seizures and status epilepticus died while still hospitalized. Two patients died 2 months after surgery and one after 4, and their deaths were related to the progression of postoperative morbidity. In the postoperative period, one of these patients developed
Follow-up
All surviving patients were monitored by timed controls; the average follow-up was 19 months with a range of 0.2 to 63.6 months. Performance status was measured according to the Karnofsky scale and the mean score, over a 12-month follow-up, was 77 with a range between 40 and 100 (Table 3).
Radiographic evidence of recurrent meningioma (in patients with prior gross total resection, and follow-up of at least 2 years) was well documented in seven cases (14.2%). Among 35 patients with residual tumor
Classification scheme
Cushing and Eisenhardt, in 1938, proposed the first classification of PFMs [10]. Castellano and Ruggiero [6] subdivided these tumors into five groups: cerebellar convexity, tentorium, posterior petrous, clivus, and foramen magnum meningiomas. However, in the last 2 decades meningiomas arising from the clivus, medial tentorium, petrous apex, and CPA have been labeled with different nomenclature by several authors 7, 9, 29, 30, 36, 57, 62. In our series, we grouped these slow-growing neoplasms
Conclusion
Despite significant advances in microsurgery and the removal of tumors using skull base techniques, PFM still represents a formidable surgical challenge for contemporary neurosurgeons. In agreement with previously published reviews, postoperative impairment of cranial nerves heavily influences the morbidity after surgery. Despite this, in our series most patients had a good long-term clinical outcome. As for supratentorial meningiomas and other benign lesions, the ideal goal of surgery remains
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2022, Journal of Clinical NeuroscienceCitation Excerpt :Posterior cranial fossa meningiomas (PCFM) comprise approximately 9–10% of intracranial meningiomas[1,2].