Meningiomas of the Skull Base: Treatment Nuances in Contemporary Neurosurgery

 

Description:

Meningiomas, the second most frequent of intracranial tumors, are characterized by a protean range of possible locations and appearances, due to their origin from the extensive and intricately formed meninges. As such, a wide variety of differential diagnoses is typical, and the therapies chosen are necessarily highly variable.

The introductory chapters of this book cover the pathology of these tumors, the evolution of special surgical methods, instrumentation, intraoperative monitoring, and the role of radiosurgery. Ten surgical chapters cover the individual regions of occurrence, including the sphenoid wing, olfactory groove, cerebellopontine angle, etc., all of which require a specialized approach and therapeutic strategy.

Key Features:

Discussion of pathology and therapy organized by anatomic location of the lesions with the goal of providing best patient outcomes

New WHO meningioma classification system based on most recent research in growth patterns, gene sequencing, and molecular patterns of development

Important updates on the newest developments in treatment modalities for meningioma, including the lesser invasive radiotherapy and radiosurgery for the smaller lesions and to avoid the necessity of performing radical surgery

Meningiomas of the Skull Base: Treatment Nuances in Contemporary Neurosurgery is an essential reference guide for neurosurgeons and neurologists (in training and in practice) and will also be welcomed by skull base surgeons and otolaryngologists.

 

Table of Contents:

 

1 Introduction

1.1 Essential “Arrows” in the Technical Quiver: Fragments of Personal Memoirs

1.2 Imaging (1973)

1.2.1 The Operating Microscope (1955)

1.2.2 Modern Endoscopy (1974)

1.2.3 Imaging Directed Stereotaxy and Navigation (1977)

1.2.4 Bipolar Forceps (1955)

1.2.5 Ultrasonic Aspirator (1978)

1.2.6 Microanatomy (1973)

2 The Evolution of Surgery—the Soul of Neurosurgery

2.1 Introduction: Early History

2.2 Nomenclature

2.3 Stages of Surgery for Meningiomas

2.4 Initial Surgical Progress

2.5 Extracranial Approaches to Skull Base Lesions

2.6 Microneurosurgery

2.7 Refined Skull Base Approaches and Anatomical Studies

2.8 Allied Advances in Meningioma Management

2.9 Modern Surgical Management

References

3 Inside the Pathology

3.1 Skull Base: Elements of Anatomy and Embryology

3.2 Surgical Resectability

3.3 Meningiomas

3.3.1 Definition and Epidemiology

3.3.2 Histopathology

3.3.3 Immunohistochemistry

3.3.4 Molecular Features

3.3.5 Prognostic Factors

3.4 Solitary Fibrous Tumor/Hemangiopericytoma

3.5 Meningiomas of the Skull Base

3.5.1 Skull Base Meningiomas in Pediatric Age

3.6 Future Perspectives

References

4 Exogenous Factors Affecting Meningiomas

4.1 Introduction

4.2 Ionizing Radiation

4.3 Exogenous Hormones

4.3.1 Link between Cyproterone Acetate and Meningiomas

4.4 Radiofrequency Electromagnetic Fields

4.5 Metabolic Syndrome and Obesity

4.6 Occupational Exposures

4.7 Smoking

4.8 Immunity

4.9 Trauma

4.10 Conclusion

References

5 Instrumentation (Micro, Endo, IGS, MRI Application)

5.1 Introduction

5.2 The Role of the Microscopy in Skull Base Surgery

5.2.1 Positioning

5.2.2 Operating Microscope

5.2.3 Microsurgical Instruments and Techniques

5.3 Endoscopy

5.3.1 Introduction

5.3.2 The Endoscope

5.3.3 Pure Endoscopic Approaches

5.3.4 Endoscope-Assisted Microneurosurgery

5.4 Image-Guided Surgery

5.5 Reconstruction Materials

5.5.1 Duraplasty and Hemostasis

References

6 Intraoperative Neurophysiologic Monitoring during Surgery

6.1 Introduction

6.2 Intraoperative Neurophysiologic Monitoring Techniques

6.2.1 Mapping Techniques to Identify Cranial Motor Nerves

6.2.2 Monitoring Techniques

6.2.3 Anesthetic Considerations

6.3 Clinical Application in Skull Base Surgery

6.3.1 IONM for Sellar and Cavernous Sinus Surgery

6.3.2 IONM for Cerebellopontine Angle Surgery

6.3.3 IONM for Jugular Foramen—Clival and Foramen Magnum Surgery

6.4 IONM Changes and Surgical Strategy

6.5 Conclusions

References

7 Role of Stereotactic Radiosurgery

7.1 Introduction

7.2 Radiobiology of Skull Base Meningiomas

7.3 Outcomes of Stereotactic Radiosurgery for Skull Base Meningiomas

7.3.1 Radiological Response

7.3.2 Cranial Neuropathy

7.3.3 Brainstem Toxicity

7.3.4 Other Complications

7.4 Management of Skull Base Meningiomas and Indications for Stereotactic Radiosurgery

7.4.1 General Indications

7.4.2 Specific Tumor Locations

7.4.3 Primary, Residual, and Recurrent Disease

7.4.4 Atypical and Anaplastic Meningiomas

7.4.5 Case Example

7.5 Conclusions

References

8 Sphenoid Wing Meningiomas

8.1 General Considerations and Definition

8.2 Lateral or Pterional Sphenoid Wing Meningiomas

8.2.1 General Aspects and Clinical Presentation

8.2.2 Evaluation

8.2.3 Indications for Procedure

8.2.4 Surgical Approach

8.3 Medial Sphenoid Wing Meningioma

8.3.1 General Aspects and Clinical Presentation

8.3.2 Evaluation

8.3.3 Indications for Procedure

8.3.4 Surgical Procedure

8.4 Final Considerations

References

9 Clival Meningiomas

9.1 Preoperative Definition of Lesion Features

9.1.1 Definition

9.1.2 Anatomical Considerations

9.2 Surgical Indications

9.3 Surgical Techniques

9.3.1 Preoperative Assessment

9.3.2 Approach Selection

9.4 Complications

9.4.1 Vascular

9.4.2 Cranial Nerve

9.4.3 Brainstem

9.4.4 CSF Leak

9.4.5 Cholesteatoma

9.5 Early and Long-term Postoperative Management

References

10 Petroclival Meningiomas

10.1 Introduction

10.2 Anatomical Considerations

10.3 Clinical Presentation

10.4 Preoperative Evaluation

10.5 Surgical Indications

10.6 Surgical Techniques

10.6.1 Retrosigmoid Approach

10.6.2 Transpetrosal Approaches

10.6.3 Anterior Petrosal Approach

10.6.4 Posterior Petrosal Approach

10.7 Complications

10.8 Early and Long-term Postoperative Management

10.9 Conclusion

References

11 Olfactory Groove Meningiomas

11.1 Introduction

11.2 Preoperative Definition of the Lesion Features

11.2.1 Anatomical Consideration

11.2.2 Clinical Presentation and Workup

11.3 Surgical Indications

11.3.1 Planning the Surgical Strategy

11.3.2 Preoperative Embolization

11.4 Surgical Techniques

11.4.1 Subfrontal Approach with Unilateral or Bilateral Frontal Craniotomy

11.4.2 Transbasal Approach

11.4.3 Pterional Approach

11.4.4 Frontolateral Approach

11.4.5 Supraorbital Keyhole Approach

11.4.6 Endoscopic Endonasal Approach

11.4.7 Algorithm for Surgical Management of Olfactory Groove Meningiomas (Endoscopic Endonasal Approaches vs. Craniotomy vs. Two-stages Strategy)

11.5 Illustrative Cases

11.5.1 Case 1

11.5.2 Case 2

11.5.3 Case 3

11.6 Complications

11.7 Early and Long-term Follow-up

11.7.1 Functional Outcomes

11.7.2 Recurrence

References

12 Middle Fossa Floor Meningiomas

12.1 Introduction

12.2 Preoperative Definition of Lesion Features

12.2.1 Surgical Anatomy of the Middle Cranial Fossa

12.2.2 Middle Cranial Fossa Floor Meningiomas

12.3 Preoperative Management

12.4 Surgical Indications

12.5 Surgical Approaches

12.5.1 Pterional Approach

12.5.2 Fronto-temporo-(orbito)-zygomatic Approach

12.5.3 Temporal Approach

12.5.4 Operative Techniques

12.6 Complications

12.6.1 How to Avoid Complications?

12.7 Long-term Outcome

12.8 Conclusion

12.9 Acknowledgment

References

13 Cerebellopontine Angle Meningiomas

13.1 Introduction

13.2 Clinical Presentation and Preoperative Evaluation

13.3 Neuroradiological Evaluation

13.4 Patient Evaluation and Decision-making

13.5 Preoperative Surgical Planning and Complication Avoidance

13.6 Surgical Approaches

13.6.1 Anterior Petroesectomy Approach

13.7 Posterior and Combined Petrosal Approaches

13.7.1 Retrolabyrinthine Approach

13.7.2 Translabyrinthine Approach

13.7.3 Combined Petrosal Approach

13.7.4 Closure of Posterior and Combined Petrosal Approaches

13.8 Retrosigmoid Approach for the Treatment of Cerebellopontine Angle Meningiomas

13.9 Postoperative Complications Avoidance

13.10 Radiosurgery for Cerebellopontine Angle Meningiomas

13.11 Conclusion

References

14 Foramen Magnum Meningioma

14.1 Introduction

14.2 History

14.3 Surgical Anatomy

14.3.1 Occipital Condyle

14.3.2 Vertebral Artery

14.4 Epidemiology, Clinical Presentation, and Imaging

14.5 Classification of Foramen Magnum Meningioma

14.6 Operative Approaches

14.6.1 Posterior Suboccipital Approach

14.6.2 Far Lateral Approach

14.6.3 Extreme Lateral Approach

14.7 Controversies in Surgical Approaches

14.7.1 Need for Condyle Resection

14.7.2 Need for C1 Laminectomy

14.7.3 Need of Vertebral Artery Mobilization

14.8 Choosing the Right Approach

14.9 Complications

14.10 Outcome

14.11 Role of Radiosurgery

14.12 Personal Experience

14.13 Conclusion

References

15 Tuberculum Sellae/Planum Meningiomas

15.1 Introduction

15.2 Preoperative Definition of Lesion Features

15.3 Surgical Indications

15.3.1 Indications for the Endoscopic Endonasal Approach

15.3.2 Indications for the Supraorbital Approach

15.4 Surgical Techniques

15.4.1 Endoscopic Endonasal Approach

15.4.2 Supraorbital Eyebrow Approach

15.5 Complications

15.6 Surgical Results

15.6.1 Endoscopic Endonasal Surgery

15.6.2 Supraorbital Surgery

15.7 Early- and Long-term Postoperative Management

15.8 Conclusion

References

16 Cavernous Sinus Meningiomas

16.1 Introduction

16.2 Anatomy

16.3 Development

16.4 Symptoms

16.5 Diagnosis

16.6 Treatment

16.7 Surgical Approaches

16.7.1 Preoperative Preparation

16.7.2 Positioning and Incision

16.7.3 Fronto-Orbitozygomatic Osteotomy

16.7.4 Drilling of the Sphenoid Ridge

16.7.5 Identification and Dissection of the Meningoorbital Band

16.7.6 Anterior Clinoidectomy

16.7.7 Unroofing the Optic Nerve

16.7.8 Extradural Exposure of the Cavernous Sinus

16.7.9 Cavernous Sinus Exploration

16.8 Surgery and Radiosurgery

16.9 Acknowledgments

References

17 Reconstruction of the Skull Base

17.1 Introduction

17.2 Reconstruction Techniques and Materials

17.2.1 Free Autografts

17.2.2 Nonautologous Materials

17.2.3 Vascularized Flaps

17.3 Current Reconstruction Techniques

17.3.1 Transcranial Approaches

17.3.2 Endoscopic Endonasal Approaches

17.4 Discussion and Conclusions

References

18 Management of Recurrent Skull Base Meningiomas

18.1 Introduction

18.2 Recurrence

18.2.1 Presentation

18.2.2 Extent of Resection

18.2.3 Location

18.2.4 Histopathology

18.2.5 Radiation-induced Meningiomas

18.2.6 Adjuvant Therapy of De Novo Meningiomas

18.2.7 Multiple Recurrences

18.3 Management

18.3.1 Surveillance

18.3.2 Surgical Resection

18.3.3 Radiation

18.3.4 Chemotherapy

18.4 Conclusion

References

19 Natural History and Adjunctive Modalities of Treatment

19.1 Introduction

19.2 Natural History

19.2.1 WHO Grade I

19.2.2 WHO Grade II

19.2.3 WHO Grade III

19.3 Adjunct Treatment Modalities

19.3.1 Radiation

19.3.2 Brachytherapy

19.3.3 Medical Therapies

19.4 Conclusion

References

20 Complications in the Management of Skull Base Meningioma

20.1 Overview

20.2 Preoperative Factors for Prediction of Complications

20.2.1 Clinicoradiological Factors

20.2.2 Multidisciplinary Approach

20.2.3 Surgeon Factors

20.2.4 Patient Factors

20.3 Perioperative, Operative Complications and Prevention

20.3.1 Anesthesia Considerations

20.3.2 Operative Complications

20.4 Postoperative Complications and Prevention

20.5 Approach-related Problems

20.5.1 Transcranial Approaches (Table 20.1, Table 20.2, and Table 20.3)

20.5.2 Transnasal Endoscopic Skull Base Approaches (Table 20.4)

20.6 Location-related Complications

20.6.1 Olfactory Groove

20.6.2 Planum and Tuberculum Sellae

20.6.3 Cavernous Sinus/Parasellar

20.6.4 Sphenoid Wing Meningioma

20.6.5 Middle Cranial Fossa Meningioma

20.6.6 Petroclival Meningioma

20.6.7 Petrous-tentorial

20.6.8 Foramen Magnum Meningioma

20.7 Conclusion

20.8 Acknowledgment

References

Index

 

An aparitie	10 Aug. 2018
Autor	Paolo Cappabianca, Domenico Solari
Dimensiuni	26.92 x 19.56 cm
Editura	Thieme
Format	Hardcover
ISBN	9783132412866
Limba	Engleza
Nr pag	234