Treatment of posterior skull base tumors.

ABSTRACT

Surgery for posterior skull base tumors may be associated with high morbidity and mortality because of the complex anatomy, irregular bony topography, and vital neurovascular structures in this region. We experienced three benign posterior skull base tumors. These were petroclival and foramen magnum meningiomas and a jugular formen neurinoma. Three dimensional computed tomography (3 D-CT) in addition to the conventional CT, magnetic resonance imaging (MRI), and cerebral angiography were performed preoperatively. Preoperative embolizations for the tumors were also done, and intraoperative neurophysiological monitorings were performed. The tumors could be subtotally removed with no damage to the brainstem, cranial nerves, and vessels. No newly developed postoperative neurological symptoms were observed. As to the remaining tumors, gamma knife (gamma-knife) therapy was planned. 3 D-CT was very useful in the preoperative evaluation of the surgical approach, and the intraoperative neurophysiological monitoring was considered to be necessary to prevent permanent damage. gamma-knife after direct approach was recommended for the benign posterior skull base tumors.