Presentation Title

Microsurgical Resection of Petroclival Meningiomas Treated with Stereotactic Radiosurgery to Address Persistent Trigeminal Pain

Speaker Credentials

OMS-I

Speaker Credentials

MS

College

Dr. Kiran C. Patel College of Osteopathic Medicine, DO

Location

Nova Southeastern University, Davie, Florida, USA

Format

Podium Presentation

Start Date

21-2-2020 8:30 AM

End Date

21-2-2020 4:00 PM

Abstract

Introduction. Petroclival meningiomas (PCM) are challenging tumors to manage, and a small percentage present with trigeminal neuralgia (TN). Observation, surgical resection and stereotactic radiosurgery (SRS) have typically been offered as treatment options. We address 3 cases where this rare and aggressive manifestation of TN was completely controlled after microsurgical resection. These cases will address the feasibility of surgery as an option to treat medically refractory TN after SRS. Deviation From The Expected. Patients with tumor driven TN generally respond well to conventional therapy or SRS, however, in this particular subset, TN persisted despite adequate tumor control. The cases reviewed showcase the novelty of microsurgical resection in patients with medically refractory TN. Case Presentation. We present three cases of patients with PCM who underwent tumor microsurgical resection to manage their medically refractory TN. Each patient failed conventional medical therapy (i.e. anti-neuropathic pain medication), and underwent SRS. Radiologic tumor control was achieved in all patients after SRS, however TN persisted despite adequate lesion management. Subsequently the 3 patients underwent micro-surgical resection. All 3 patients had complete resolution of their TN pain, with a BNI score of 1 at median follow up of 26 months. Discussion. Tumor control after SRS in patients with PCM is over 95%. For these patients, the goal of surgery was to address their persistent TN through surgically removing any tumor remnants that persisted after SRS. Conclusion. Microsurgical resection is a good option for patients with persistent facial pain after SRS treatment of PCM complicated by medically refractory TN.

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Feb 21st, 8:30 AM Feb 21st, 4:00 PM

Microsurgical Resection of Petroclival Meningiomas Treated with Stereotactic Radiosurgery to Address Persistent Trigeminal Pain

Nova Southeastern University, Davie, Florida, USA

Introduction. Petroclival meningiomas (PCM) are challenging tumors to manage, and a small percentage present with trigeminal neuralgia (TN). Observation, surgical resection and stereotactic radiosurgery (SRS) have typically been offered as treatment options. We address 3 cases where this rare and aggressive manifestation of TN was completely controlled after microsurgical resection. These cases will address the feasibility of surgery as an option to treat medically refractory TN after SRS. Deviation From The Expected. Patients with tumor driven TN generally respond well to conventional therapy or SRS, however, in this particular subset, TN persisted despite adequate tumor control. The cases reviewed showcase the novelty of microsurgical resection in patients with medically refractory TN. Case Presentation. We present three cases of patients with PCM who underwent tumor microsurgical resection to manage their medically refractory TN. Each patient failed conventional medical therapy (i.e. anti-neuropathic pain medication), and underwent SRS. Radiologic tumor control was achieved in all patients after SRS, however TN persisted despite adequate lesion management. Subsequently the 3 patients underwent micro-surgical resection. All 3 patients had complete resolution of their TN pain, with a BNI score of 1 at median follow up of 26 months. Discussion. Tumor control after SRS in patients with PCM is over 95%. For these patients, the goal of surgery was to address their persistent TN through surgically removing any tumor remnants that persisted after SRS. Conclusion. Microsurgical resection is a good option for patients with persistent facial pain after SRS treatment of PCM complicated by medically refractory TN.