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At present, only sporadic literature has reported the complications associated with this approach in detail, for which Professor Froelich of the Lariboisière Hospital in Paris, France, and others summarized the team's experience in 49 surgeries, and the results were published online
in March 2022.
——Excerpt from the article chapter
Article Source: Giammattei L, Passeri T, Abbritti R, Lieber S, Matano F, Le Van T, Okano A, Fava A, Russo PD, Froelich S.
J Neurosurg.
2022 May 13:1-11.
doi: 10.
3171/2022.
3.
JNS212962.
Epub ahead of print.
Research background
The Metadural Anterior Petrosal Approach (EAPA) has been around for decades, and complications including temporal lobe injury, hearing loss, facial palsy, and cerebrospinal fluid leakage have always been a concern for
surgeons.
At present, only sporadic literature has reported the complications associated with this approach in detail, for which Professor Froelich of the Lariboisière Hospital in Paris, France, and others summarized the team's experience in 49 surgeries, and the results were published online
in March 2022.
Research Methods
Retrospective analysis of the data of patients undergoing EAPA surgery at the center between 2012 and 2021, including preoperative features, surgical records, surgical videos, imaging findings, pathological diagnosis, postoperative procedures and follow-up status.
For those whose lesions do not involve rock tips, the range of rock tip grinding is divided into two categories
: more (at least 70%) and less (<70%).
Complication analysis is further divided into two categories: approach correlation and tumor resection correlation
.
Results of the study
In the end, 49 patients (male: female 23:26, mean age 46.
0±13.
0 years, average follow-up 34.
3±27.
6 months), all of whom were led by Professor Froelich, of which 26 were meningiomas (19 cases of maliciomas [PCMs], 2 cases of sphenoid oblique meningioma [SPCMs], 5 cases of meningioma [MCMs]), 10 cases of cavernous hemangioma of the brainstem, 4 cases of chondrosarcoma, 4 cases of choroidoma, 2 cases of schwannoma of neurosphinoma, 1 case of epidermoid cyst, There was 1 case of cholesterol granuloma and 1 case of
osteoblastoma.
The most common path-related complications were temporal lobe injury (6.
1%), epilepsy (6.
1%), pseudomeningocele (6.
1%), hearing impairment (4.
1%), and dry eye (4.
1%), with meningioma (p=0.
02) and path-related complications most likely in patients with Myceli's sac invasion (p=0.
02), as detailed in Table 1
.
The occurrence of complications associated with tumor resection is associated with total resection or subtotal resection (p=0.
02) and is not related
to the isotropic expansion of the tumor.
In addition, the grinding range of the rock tip is independent
of the occurrence of two types of complications.
Approach-related complications table 2.
Table 3 of complications associated with tumor resection.
Influence of pathological and radiographic features on the occurrence of complications
Conclusion of the study
The complication rate of EAPA is within an acceptable range, which remains a safe surgical approach that can be greatly reduced
through detailed preoperative assessment, sound patient selection, and sophisticated surgical techniques.
