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2016 ; 8
(4
): e588
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Management of Intracranial Meningiomas Using Keyhole Techniques
#MMPMID27284496
Burks JD
; Conner AK
; Bonney PA
; Archer JB
; Christensen B
; Smith J
; Safavi-Abbasi S
; Sughrue M
Cureus
2016[Apr]; 8
(4
): e588
PMID27284496
show ga
BACKGROUND: Keyhole craniotomies are increasingly being used for lesions of the
skull base. Here we review our recent experience with these approaches for
resection of intracranial meningiomas. METHODS: Clinical and operative data were
gathered on all patients treated with keyhole approaches by the senior author
from January 2012 to June 2013. Thirty-one meningiomas were resected in 27
patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6
posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO
Grade I, and 2 were Grade II. RESULTS: The mean operative time was 8 hours, 22
minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes
(range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as
follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative
hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with
some degree of visual loss, 7 saw improvement or complete resolution. In the 6
patients presenting with cranial nerve palsies, 4 experienced improvement or
resolution of the deficit postoperatively. Four patients experienced new
neurologic deficits, all of which were improved or resolved at the time of the
last follow-up. Technical aspects and surgical nuances of these approaches for
management of intracranial meningiomas are discussed. CONCLUSIONS: With careful
preoperative evaluation, keyhole approaches can be utilized singly or in
combination to manage meningiomas in a wide variety of locations with
satisfactory results.