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Skull base surgery. 1993 April; 3(2): 91–106.
PMCID: PMC1656425

Meningiomas with Vertebrobasilar Artery Encasement

Review of 17 Cases

Abstract

Seventeen patients with petroelival and foramen magnum meningiomas encasing the vertebral or basilar arteries and their branches were surgically excised over a 3-year period. All six cases with vertebral artery encasement were totally excised. One vertebral artery was occluded, one was repaired, and one was replaced with a vein graft. None of the patients had a permanent major neurologic deficit. In one patient with vertebral and basilar artery encasement, a hypoplastic vertebral artery was occluded and the tumor was totally excised. She had a transient worsening of hemiparesis, presumably due to the dissection of tumor from the brainstem. Among the ten patients with encasement of the basilar artery and branches, injury to the basilar artery occurred in two patients, both were repaired. Injuries to one superior cerebellar artery, one anterior inferior cerebellar artery, and one perforating vessel could not be repaired. Three patients sustained major neurologic deficits, but only in two did this result in permanent functional deterioration. Three of the ten patients had a gross total resection, five had subtotal resection (90% or more of tumor volume), and two had resection of 70% of the tumor volume. Eight patients had improvement in their Karnofsky scores. None showed recurrence or regrowth on follow-up ranging from 2 to 6 years. Greater difficulty with dissection was experienced in previously operated patients, and in patients who did not have an arachnoid plane between the brainstem and the tumor. Magnetic resonance imaging was the most useful preoperative test. It is concluded that meningiomas with vertebrobasilar artery encasement can be removed successfully with modern skull base surgery techniques. The surgeon needs to exercise caution and judgment in deciding how far the removal of these lesions should be pursued.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Al-Mefty O. Clinoidal meningiomas. J Neurosurg. 1990 Dec;73(6):840–849. [PubMed]
  • Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery. 1988 Mar;22(3):510–517. [PubMed]
  • Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery. 1985 Mar;16(3):364–372. [PubMed]
  • Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986 Sep;26(3):271–276. [PubMed]
  • Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol. 1988 Aug;30(2):108–116. [PubMed]
  • Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991 Jun;28(6):869–876. [PubMed]
  • Malis LI. Tumors of the parasellar region. Adv Neurol. 1976;15:281–299. [PubMed]
  • Mayberg MR, Symon L. Meningiomas of the clivus and apical petrous bone. Report of 35 cases. J Neurosurg. 1986 Aug;65(2):160–167. [PubMed]
  • Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery. 1989 Jan;24(1):12–17. [PubMed]
  • Sekhar LN, Jannetta PJ, Burkhart LE, Janosky JE. Meningiomas involving the clivus: a six-year experience with 41 patients. Neurosurgery. 1990 Nov;27(5):764–781. [PubMed]
  • Sekhar LN, Møller AR. Operative management of tumors involving the cavernous sinus. J Neurosurg. 1986 Jun;64(6):879–889. [PubMed]
  • Sekhar LN, Sen CN, Jho HD, Janecka IP. Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery. 1989 Jan;24(1):18–30. [PubMed]
  • Sekhar LN, Sen CN, Jho HD. Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg. 1990 Jan;72(1):35–41. [PubMed]
  • Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery. 1990 Aug;27(2):197–204. [PubMed]

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