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Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia

 Hun Ho Park  ;  Woo Hyun Kim  ;  Hyun-Ho Jung  ;  Jong Hee Chang  ;  Kyu-Sung Lee  ;  Won Seok Chang  ;  Chang-Ki Hong 
 NEUROSURGICAL REVIEW, Vol.43(6) : 1631-1640, 2020-12 
Journal Title
Issue Date
Gamma knife radiosurgery ; Microsurgery ; Skull base surgery ; Small petroclival meningioma ; Trigeminal neuralgia
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm3, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Lee, Kyu Sung(이규성)
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Jung, Hyun Ho(정현호)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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