Cargando…

Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging

OBJECTIVE: Parasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is c...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Yang, Zhang, XingShu, Su, Jun, Qin, Chaoying, Wang, Xiangyu, Xiao, Kai, Liu, Qing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674204/
https://www.ncbi.nlm.nih.gov/pubmed/34926280
http://dx.doi.org/10.3389/fonc.2021.771431
_version_ 1784615598664187904
author Li, Yang
Zhang, XingShu
Su, Jun
Qin, Chaoying
Wang, Xiangyu
Xiao, Kai
Liu, Qing
author_facet Li, Yang
Zhang, XingShu
Su, Jun
Qin, Chaoying
Wang, Xiangyu
Xiao, Kai
Liu, Qing
author_sort Li, Yang
collection PubMed
description OBJECTIVE: Parasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging. METHODS: A retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively. RESULTS: Total resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively. CONCLUSIONS: Preoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life.
format Online
Article
Text
id pubmed-8674204
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-86742042021-12-17 Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging Li, Yang Zhang, XingShu Su, Jun Qin, Chaoying Wang, Xiangyu Xiao, Kai Liu, Qing Front Oncol Oncology OBJECTIVE: Parasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging. METHODS: A retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively. RESULTS: Total resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively. CONCLUSIONS: Preoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life. Frontiers Media S.A. 2021-12-02 /pmc/articles/PMC8674204/ /pubmed/34926280 http://dx.doi.org/10.3389/fonc.2021.771431 Text en Copyright © 2021 Li, Zhang, Su, Qin, Wang, Xiao and Liu https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Li, Yang
Zhang, XingShu
Su, Jun
Qin, Chaoying
Wang, Xiangyu
Xiao, Kai
Liu, Qing
Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title_full Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title_fullStr Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title_full_unstemmed Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title_short Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging
title_sort individualized cerebral artery protection strategies for the surgical treatment of parasellar meningiomas on the basis of preoperative imaging
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674204/
https://www.ncbi.nlm.nih.gov/pubmed/34926280
http://dx.doi.org/10.3389/fonc.2021.771431
work_keys_str_mv AT liyang individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT zhangxingshu individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT sujun individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT qinchaoying individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT wangxiangyu individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT xiaokai individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging
AT liuqing individualizedcerebralarteryprotectionstrategiesforthesurgicaltreatmentofparasellarmeningiomasonthebasisofpreoperativeimaging