The Radiographic Effects of Surgical Approach and Use of Retractors On the Brain after Anterior Cranial Fossa Meningioma Resection.

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The Radiographic Effects of Surgical Approach and Use of Retractors On the Brain after Anterior Cranial Fossa Meningioma Resection.

World Neurosurg. 2018 Jan 20;:

Authors: Chaichana KL, Vivas-Buitrago T, Jackson C, Ehresman J, Olivi A, Bettegowda C, Quinones-Hinojosa A

Abstract
OBJECTIVE: There is a growing trend towards skull base (SB) approaches and retractorless surgery to minimize brain manipulation during surgery. We evaluated the radiographic changes over time after surgical resection of anterior cranial fossa meningiomas with and without both SB approaches and/or fixed retractor systems.
METHODS: All adults undergoing primary resection of an anterior cranial fossa WHO grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010-2015 were retrospectively reviewed. MRI scans were reviewed and contrast-enhanced tumor and fluid-attenuated inversion recovery (FLAIR) volumes were measured. Matched-pair analyses between patients who underwent SB and non-SB approaches, as well as retractorless and retractor-assisted (RA) surgery were made.
RESULTS: Of the 136 total patients, 20(15%), 12(9%), 46(34%), and 58(43%) underwent SB/retractorless, SB/RA, non-SB/retractorless, and non-SB/RA surgery, respectively. Patients who underwent non-SB and RA surgery each independently had longer times to FLAIR resolution than SB (20.9 vs. 5 months, p=0.04) and retractorless (12 vs. 5.2 months, p=0.02) surgery, respectively. Patients who underwent both non-SB and RA surgery had the longest median time to FLAIR resolution [30 months vs. 4 months in SB/retractorless, 3.6 months in SB/RA, and 3 months in non-SB/retractorless, p<0.05].
CONCLUSIONS: The use of SB approaches in combination with retractorless surgery may increase decrease the duration needed for FLAIR resolution following surgery. The results from this study therefore advocate for SB approaches and retractorless surgery along the anterior skull base when possible.

PMID: 29367000 [PubMed - as supplied by publisher]

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