The Radiographic Effects of Surgical Approach and Use of Retractors on the Brain After Anterior Cranial Fossa Meningioma Resection

Kaisorn L. Chaichana, Tito Vivas-Buitrago, Christina Jackson, Jeffrey Ehresman, Alessandro Olivi, Chetan Bettegowda, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: There is an increasing trend toward 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 World Health Organization grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010 to 2015 were retrospectively reviewed. Magnetic resonance imaging 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 those who underwent 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 decrease the duration needed for FLAIR resolution after surgery. The results from this study therefore advocate SB approaches and retractorless surgery along the anterior SB when possible.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Anterior Cranial Fossa
Skull Base
Meningioma
Brain
Matched-Pair Analysis
Craniotomy
Tertiary Healthcare

Keywords

  • Anterior skull base surgery
  • Edema
  • FLAIR
  • Meningioma
  • Orbitozygomatic
  • Retractor
  • Retractorless
  • Skull base

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Radiographic Effects of Surgical Approach and Use of Retractors on the Brain After Anterior Cranial Fossa Meningioma Resection. / Chaichana, Kaisorn L.; Vivas-Buitrago, Tito; Jackson, Christina; Ehresman, Jeffrey; Olivi, Alessandro; Bettegowda, Chetan; Quinones-Hinojosa, Alfredo.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Chaichana, Kaisorn L. ; Vivas-Buitrago, Tito ; Jackson, Christina ; Ehresman, Jeffrey ; Olivi, Alessandro ; Bettegowda, Chetan ; Quinones-Hinojosa, Alfredo. / The Radiographic Effects of Surgical Approach and Use of Retractors on the Brain After Anterior Cranial Fossa Meningioma Resection. In: World Neurosurgery. 2018.
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abstract = "Objective: There is an increasing trend toward 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 World Health Organization grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010 to 2015 were retrospectively reviewed. Magnetic resonance imaging 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 those who underwent 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 decrease the duration needed for FLAIR resolution after surgery. The results from this study therefore advocate SB approaches and retractorless surgery along the anterior SB when possible.",
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AU - Chaichana, Kaisorn L.

AU - Vivas-Buitrago, Tito

AU - Jackson, Christina

AU - Ehresman, Jeffrey

AU - Olivi, Alessandro

AU - Bettegowda, Chetan

AU - Quinones-Hinojosa, Alfredo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: There is an increasing trend toward 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 World Health Organization grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010 to 2015 were retrospectively reviewed. Magnetic resonance imaging 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 those who underwent 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 decrease the duration needed for FLAIR resolution after surgery. The results from this study therefore advocate SB approaches and retractorless surgery along the anterior SB when possible.

AB - Objective: There is an increasing trend toward 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 World Health Organization grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010 to 2015 were retrospectively reviewed. Magnetic resonance imaging 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 those who underwent 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 decrease the duration needed for FLAIR resolution after surgery. The results from this study therefore advocate SB approaches and retractorless surgery along the anterior SB when possible.

KW - Anterior skull base surgery

KW - Edema

KW - FLAIR

KW - Meningioma

KW - Orbitozygomatic

KW - Retractor

KW - Retractorless

KW - Skull base

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