Results of surgical treatment of posterior cranial fossa meningiomas

Abstract

Surgery of meningiomas of the posterior cranial fossa, due to its small volume and close anatomical relationship of neoplasms with the brain stem, cranial nerves, main arteries and venous collectors, remains one of the urgent problems of neurooncology. Despite the improvement of microsurgical techniques and neurophysiological control, maintaining a high level of quality of life after radical removal of meningiomas is still far from desired. Purpose of the study. Retrospective analysis and generalization of clinical results of surgical treatment of patients with meningiomas of the posterior cranial fossa. Material and methods. The paper analyzes the results of surgical treatment of 101 patient with meningiomas of the posterior cranial fossa of various localization (80 women (79.2 %) and 21 men (20.7 %), age 58.26 ± 1.00 years). According to the localization of meningiomas, they were distributed as follows: convexital – 49 (48.5 %), cerebellopontine angle – 22 (21.8 %), jugular foramen – 4 (4 %), petroclival – 16 (15.8 %), foramen magnum – 10 (9.9 %). Results. All patients underwent surgical removal of the formation. In 99 (98 %) one-stage and in 2 (1.9 %) cases of additional surgical intervention, in the form of external drainage according to Arendt and ventriculoperitoneal shunting, due to frolicking liquorodynamic disorders. Radical removal of meningioma (grade I according to Simpson scale) was achieved in 72 (71.3 %) of cases, tumor resection with coagulation of the tumor matrix zone (Simpson II) – in 21 (20.8 %), removal without resection and coagulation of the matrix, or leaving the extradural component of meningiomas (Simpson III) – in 8 (7.9 %). Conclusions. The results obtained on the basis of the complex use of modern neuroimaging diagnostic tools, microneurosurgery, optimal surgical approaches in combination with the mandatory intraoperative physiological control of the function of the brain stem and cranial nerves in the early postoperative period indicate an improvement in the functional state, and sometimes complete regression of the neurological symptoms in 58 (57.4 %) of operated patients. Complete regression of symptoms and restoration of the functional state was achieved in 30 (29.7 %) of cases, deterioration was noted in 17 (16.8 %) of the operated patients, mortality was 4.95 % (n = 5).