J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679549
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Safe Maximal Resection of Primary Cavernous Sinus Meningiomas via a Minimal Anterior and Posterior Combined Transpetrosal Approach

Kenji Ohata
1   Department of Neurosurgery, Osaka City University, Osaka, Japan
,
Hiroiki Morisako
1   Department of Neurosurgery, Osaka City University, Osaka, Japan
,
Hiroki Ohata
1   Department of Neurosurgery, Osaka City University, Osaka, Japan
,
Takeo Goto
1   Department of Neurosurgery, Osaka City University, Osaka, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2019 (online)

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    Objective: Meningiomas arising from the cavernous sinus (CS) continue to be a significant technical challenge, and resection continues to carry a relatively higher risk of neurological morbidity in patients with these lesions because of the tumor's proximity to neurovascular structures. The authors report the surgical outcomes of 9 patients with primary CS meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.

    Methods: This retrospective study included nine patients who underwent surgery for CSM treatment for the last 2 years via the MAPC transpetrosal approach. Two patients were men and 7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital craniotomy and exposure of the posterolateral part of the CS via the presigmoid MAPC approach. After opening Meckel's cave and identifying the 3rd-5th cranial nerves in the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened. Finally, the tumor occupying the posterolateral part of the CS was removed.

    Results: All lesions were safely and maximally removed, with preservation of external ocular movements and preoperative Karnofsky Performance Scale scores. The mean extent of resection was 77.0% (range: 58.7–95.4%). Six patients underwent adjuvant therapy in the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during the follow-up period; none of these patients experienced recurrence.

    Conclusion: The authors conclude that the MAPC transpetrosal approach could be superior to other approaches for CSMs, as it provides direct visual access to the posterolateral portion of the CS. In their experience, this approach is an alternative and better option for safe maximal resection of CSMs.


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    No conflict of interest has been declared by the author(s).