Download PDF
J Neurol Surg B Skull Base 2019; 80(04): 380-391
DOI: 10.1055/s-0038-1675589
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Approach Selection and Surgical Planning in Posterior Cranial Fossa Meningiomas: How I Do It

André Beer-Furlan
1   Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, United States
,
Eduardo A. Vellutini
2   DFVneuro - Division of Neurosurgery, São Paulo, São Paulo, Brazil
,
Marcos Q. T. Gomes
2   DFVneuro - Division of Neurosurgery, São Paulo, São Paulo, Brazil
,
Alberto C. Cardoso
2   DFVneuro - Division of Neurosurgery, São Paulo, São Paulo, Brazil
,
Luciano M. Prevedello
3   Department of Radiology, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Alexandre B. Todeschini
4   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Daniel M. Prevedello
4   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
› Author Affiliations Disclosure of Funding None.
Further Information

Publication History

01 June 2018

23 September 2018

Publication Date:
31 October 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Posterior cranial fossa meningiomas represent approximately 9% of all the intracranial meningiomas. Despite the recent reports of radiation therapy in the management of these tumors, surgical resection continues to be the first line of treatment method aiming the permanent meningioma eradication. The evolution of imaging studies improved the preoperative evaluation of meningiomas providing greater anatomical detail of small structures not previously visualized. Nonetheless, the preoperative radiological evaluation should go beyond the differential diagnosis of a posterior fossa tumor. Anatomo-radiological assessment of meningiomas is discussed in detail. Based on our clinical experience, literature review, and case illustration, we highlight important preoperative anatomo-radiological aspects of posterior fossa meningiomas and their implications in the surgical management of these tumors.

Keywords

meningioma - posterior fossa - clival meningioma - petroclival meningioma - foramen magnum meningioma - jugular foramen meningioma - cerebellopontine angle meningioma - surgical approaches
 

  • References

  • 1 Campbell E, Whitfield RD. Posterior fossa meningiomas. J Neurosurg 1948; 5 (02) 131-153
    CrossrefPubMedGoogle Scholar
  • 2 Castellano F, Ruggiero G. Meningiomas of the posterior fossa. Acta Radiol Suppl 1953; 104: 1-177
    PubMedGoogle Scholar
  • 3 Maclean J, Fersht N, Short S. Controversies in radiotherapy for meningioma. Clin Oncol (R Coll Radiol) 2014; 26 (01) 51-64
    CrossrefPubMedGoogle Scholar
  • 4 Rogers L, Barani I, Chamberlain M. , et al. Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 2015; 122 (01) 4-23
    CrossrefPubMedGoogle Scholar
  • 5 Cushing H. Meningiomas. Their Classification, Regional Behaviour, Life History, and Surgical End Results. Baltimore; Thomas: 1938
  • 6 Sekhar LN, Wright DC, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neurooncol 1996; 29 (03) 249-259
    CrossrefPubMedGoogle Scholar
  • 7 Al-Mefty O. Preface. In: Al-Mefty O, ed. Meningiomas. New York: Raven Press; 1991. :vii
  • 8 Buetow MP, Buetow PC, Smirniotopoulos JG. Typical, atypical, and misleading features in meningioma. Radiographics 1991; 11 (06) 1087-1106
    CrossrefPubMedGoogle Scholar
  • 9 Ojemann RG. Management of cranial and spinal meningiomas (honored guest presentation). Clin Neurosurg 1993; 40: 321-383
    PubMedGoogle Scholar
  • 10 Osborn AG, Salzman KL, Barkovich AJ. Meningioma and atypical and malignant meningioma. In: Osborn AG ed. Diagnostic Imaging: Brain. Salt Lake City; Lippincott Williams & Wilkins: 2009: 72-81
  • 11 Hallinan JT, Hegde AN, Lim WE. Dilemmas and diagnostic difficulties in meningioma. Clin Radiol 2013; 68 (08) 837-844
    CrossrefPubMedGoogle Scholar
  • 12 Nagar VA, Ye JR, Ng WH. , et al. Diffusion-weighted MR imaging: diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation. AJNR Am J Neuroradiol 2008; 29 (06) 1147-1152
    CrossrefPubMedGoogle Scholar
  • 13 Yue Q, Isobe T, Shibata Y. , et al. New observations concerning the interpretation of magnetic resonance spectroscopy of meningioma. Eur Radiol 2008; 18 (12) 2901-2911
    CrossrefPubMedGoogle Scholar
  • 14 Mikami T, Minamida Y, Yamaki T, Koyanagi I, Nonaka T, Houkin K. Cranial nerve assessment in posterior fossa tumors with fast imaging employing steady-state acquisition (FIESTA). Neurosurg Rev 2005; 28 (04) 261-266
    CrossrefPubMedGoogle Scholar
  • 15 Farb RI, Scott JN, Willinsky RA, Montanera WJ, Wright GA, terBrugge KG. Intracranial venous system: gadolinium-enhanced three-dimensional MR venography with auto-triggered elliptic centric-ordered sequence--initial experience. Radiology 2003; 226 (01) 203-209
    CrossrefPubMedGoogle Scholar
  • 16 Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg 1999; 90 (2, Suppl): 206-219
    CrossrefPubMedGoogle Scholar
  • 17 Hafez A, Nader R, Al-Mefty O. Preservation of the superior petrosal sinus during the petrosal approach. J Neurosurg 2011; 114 (05) 1294-1298
    CrossrefPubMedGoogle Scholar
  • 18 Schmitz B, Hagen T, Reith W. Three-dimensional true FISP for high-resolution imaging of the whole brain. Eur Radiol 2003; 13 (07) 1577-1582
    CrossrefPubMedGoogle Scholar
  • 19 Sekhar LN, Swamy NK, Jaiswal V, Rubinstein E, Hirsch Jr WE, Wright DC. Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 1994; 81 (06) 860-868
    CrossrefPubMedGoogle Scholar
  • 20 Shiroishi MS, Cen SY, Tamrazi B. , et al. Predicting meningioma consistency on preoperative neuroimaging studies. Neurosurg Clin N Am 2016; 27 (02) 145-154
    CrossrefPubMedGoogle Scholar
  • 21 Beer-Furlan A, Todeschini AB, Carrau RL. , et al. Endoscopic endonasal approach for posterior fossa tumors. In: Couldwell WT ed. Skull Base Surgery of the Posterior Fossa. 1 st edition. Springer International Publishing; 2017: 75-86
  • 22 Beer-Furlan A, Vellutini EA, Balsalobre L, Stamm AC. Endoscopic endonasal approach to ventral posterior fossa meningiomas: from case selection to surgical management. Neurosurg Clin N Am 2015; 26 (03) 413-426
    CrossrefPubMedGoogle Scholar
  • 23 Beer-Furlan A, Abi-Hachem R, Jamshidi AO, Carrau RL, Prevedello DM. Endoscopic trans-sphenoidal surgery for petroclival and clival meningiomas. J Neurosurg Sci 2016; 60 (04) 495-502
    PubMedGoogle Scholar