• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.610-617
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• 2019

Objective : This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve. Methods : The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications. Results : Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6-66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation. Conclusion : PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.479-488
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• 2022

Objective : The surgical management of trigeminal neuralgia (TN) caused by petrous apex meningioma (PAM) is still a challenge because of the lesion's deep location and the surrounding complex structures. The authors describe the intradural anterior transpetrosal approach (ATPA) and its effect on the treatment of TN secondary to PAM. Methods : A retrospective analysis of 15 patients with TN secondary to PAM who underwent surgery via the intradural ATPA was conducted. The key techniques, which included drilling off the petrosal apex (PA) and opening the upper wall of Meckel's cave (MC), are described in detail. Results : Total removal of the tumor and complete pain relief (Barrow Neurological Institute I) were achieved in all 15 patients without significant morbidity. Five patients developed new facial numbness postoperatively, which disappeared within three months after surgery. The postoperative magnetic resonance imaging showed temporal lobe swelling in three patients, but no clinical symptoms. One patient had cerebrospinal fluid leakage and was managed with bed rest and temporary lumbar drainage. One patient had an intracranial infection and was treated with antibiotics. By the last follow up, no patients had pain relapse or/and tumor recurrence. It is worth noting that the vascular compression at the root of the trigeminal nerve was found in one patient during the operation. Conclusion : Our experience suggests that drilling off the PA and opening the upper wall of the MC are key elements for a good outcome of the treatment of TN secondary to PAM. The intradural ATPA has the advantages for both tumor resection and pain relief.