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J Neurol Surg B Skull Base 2021; 82(04): 466-475
DOI: 10.1055/s-0040-1713100
Original Article

Retrosigmoid Transtentorial Approach Compared to Traditional Transpetrosal Approaches for the Resection of Petroclival Meningiomas: A Case-Control Study

Ribhu T. Jha
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Paul McBride
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Gleb Zavadskiy
2   Muma College of Business, University of South Florida, Tampa, Florida, United States
,
Harry R. van Loveren
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Siviero Agazzi
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
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Abstract

Background Transpetrosal approaches have become standard technique for resection of petroclival meningiomas (PCM). The retrosigmoid craniotomy has also been extensively studied as an alternative approach. The need to resect the tentorium at the end of a retrosigmoid approach has been described, but the upfront transtentorial variation of the retrosigmoid craniotomy has never been described nor evaluated in detail as a possible alternative to the standard petrosectomy approaches.

Objective This study was aimed to directly compare the transpetrosal approaches to the retrosigmoid transtentorial approach (RSTTA) in terms of degree of resection, duration of surgery, and estimated blood loss (EBL).

Methods A retrospective case-control study of patients who underwent resection of PCM between January 2014 and December 2018 was performed. Patients in the two surgical approach groups were matched for age and tumor location. The primary measured outcomes were duration of surgery, EBL, extent of resection, length of postoperative hospital stay, and complications. Data analysis was performed using analysis of variance (ANOVA), multivariate analysis of variance (MANOVA), and analysis of covariance (ANCOVA) tests.

Results Thirteen patients had microsurgical resection of PCM at our center between January 2014 and December 2018. Nine patients underwent a transpetrosal approach and four patients underwent RSTTA. The average duration of surgery was shorter in the RSTTA group (425 vs. 525.4 minutes) and had less blood loss (94 vs. 425 mL). Extent of resection was comparable between the groups.

Conclusion The RSTTA appears to be a safe and efficient technique for resecting PCMs and in selected cases a valid alternative to standard petrosectomies approaches.

Keywords

petroclival meningioma - retrosigmoid transtentorial - RSTTA - transpetrosal


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Eingereicht: 08. November 2019

Angenommen: 12. April 2020

Artikel online veröffentlicht:
19. Juni 2020

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