{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:21:32Z","timestamp":1761823292952},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,11]]},"abstract":"\nObject<\/jats:title>\nBecause resection followed by timely stereotactic radiosurgery (SRS) is becoming a standard strategy for skull base meningiomas, the role of initial surgical tumor reduction in this combined treatment should be clarified.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThis study examined 161 patients with benign skull base meningiomas surgically treated at Osaka City University between January 1985 and December 2005. The mean follow-up period was 95.3 months. Patients were categorized into 3 groups based on the operative period and into 4 groups based on tumor location. Maximal resection was performed as first therapy throughout all periods. In the early period (1985\u20131994), in the absence of SRS, total excision of the tumor was intentionally performed for surgical cure of the disease. In the mid and late periods (1995\u20132000 and 2001\u20132005), small parts of the tumor invading critical neurovascular structures were left untouched to obtain good functional results. Residual tumors with high proliferation potential (Ki 67 index > 4%) or with progressive tendencies were treated with SRS. The extent of initial tumor resection, recurrence rate, Karnofsky Performance Scale score, and complication rate were investigated in each group.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe mean tumor equivalent diameter of residual tumors was 3.67 mm in the no-recurrence group and 11.7 mm in the recurrence group. The mean tumor resection rate (TRR) was 98.5% in the no-recurrence group and 90.1% in the recurrence group. A significant relationship was seen between postoperative tumor size, TRR, and recurrence rate (p < 0.001), but the recurrence rate showed no significant relationship with any other factors such as operative period (p = 0.48), tumor location (p = 0.76), or preoperative tumor size (p = 0.067). The mean TRR was maintained throughout all operative periods, but the complication rate was lowest and postoperative Karnofsky Performance Scale score was best in the late period (p < 0.001 each). Late-period results were as follows: mean TRR, 97.9%; mortality rate, 0%; and severe morbidity rate, 0%. Stereotactic radiosurgery procedures were added in 27 cases (16.8%) across all periods. Throughout all follow-up periods, 158 tumors were satisfactorily controlled by maximal possible excision alone or in combination with adequate SRS.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe combination of maximal possible resection and additional SRS improves functional outcomes in patients with skull base meningioma. A TRR greater than 97% in volume can be achieved with satisfactory functional preservation and will lead to excellent tumor control in combined treatment of skull base meningioma.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.2.jns091118","type":"journal-article","created":{"date-parts":[[2010,3,12]],"date-time":"2010-03-12T13:47:48Z","timestamp":1268401668000},"page":"1072-1078","source":"Crossref","is-referenced-by-count":53,"title":["The role of radical microsurgical resection in multimodal treatment for skull base meningioma"],"prefix":"10.3171","volume":"113","author":[{"given":"Tsutomu","family":"Ichinose","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeo","family":"Goto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Ishibashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshihiro","family":"Takami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Ohata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns091118","series-title":"J Neurosurg","first-page":"1014","article-title":"Meningiomas of the posterior petrous bone: functional outcome after microsurgery","volume":"100","author":"Bassiouni","year":"2004"},{"key":"b2-jns091118","series-title":"Neurosurgery","first-page":"813","article-title":"Microsurgical removal of petroclival meningiomas: a report of 33 patients","volume":"31","author":"Bricolo","year":"1992"},{"key":"b3-jns091118","series-title":"J Neurooncol","first-page":"241","article-title":"Linear accelerator-based radiosurgery in the management of skull base meningiomas","volume":"66","author":"Chuang","year":"2004"},{"key":"b4-jns091118","series-title":"J Neurosurg","first-page":"30","article-title":"Patterns of skull base meningioma progression after failed radiosurgery","volume":"106","author":"Couldwell","year":"2007"},{"key":"b5-jns091118","series-title":"J Neurosurg","first-page":"20","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","author":"Couldwell","year":"1996"},{"key":"b6-jns091118","series-title":"J Neurosurg","first-page":"245","article-title":"Outcome of aggressive removal of cavernous sinus meningiomas","volume":"81","author":"DeMonte","year":"1994"},{"key":"b7-jns091118","series-title":"J Neurooncol","first-page":"255","article-title":"Meningiomas of the cranial base","volume":"20","author":"Desai","year":"1994"},{"key":"b8-jns091118","series-title":"Neurol Med Chir (Tokyo)","first-page":"63","article-title":"Clivus meningioma: six cases of total removal","volume":"17","author":"Hakuba","year":"1977"},{"key":"b9-jns091118","series-title":"J Neurosurg","first-page":"745","article-title":"Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma","volume":"107","author":"Hasegawa","year":"2007"},{"key":"b10-jns091118","series-title":"J Neurosurg","first-page":"804","article-title":"Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. Clinical article","volume":"109","author":"Iwai","year":"2008"},{"key":"b11-jns091118","series-title":"J Neurooncol","first-page":"109","article-title":"New prospects for management and treatment of inoperable and recurrent skull base meningiomas","volume":"86","author":"Johnson","year":"2008"},{"key":"b12-jns091118","series-title":"Neurosurgery","first-page":"567","article-title":"Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases","volume":"46","author":"Jung","year":"2000"},{"key":"b13-jns091118","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1425","article-title":"Long term experience of gamma knife radiosurgery for benign skull base meningiomas","volume":"76","author":"Kreil","year":"2005"},{"key":"b14-jns091118","series-title":"J Neurosurg","first-page":"65","article-title":"Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas","volume":"97","author":"Lee","year":"2002"},{"key":"b15-jns091118","series-title":"Neurosurgery","first-page":"221","article-title":"Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas","volume":"45","author":"Levine","year":"1999"},{"key":"b16-jns091118","series-title":"Neurosurgery","first-page":"546","article-title":"Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients","volume":"56","author":"Little","year":"2005"},{"key":"b17-jns091118","series-title":"Neurosurgery","first-page":"2","article-title":"Recurrence of cranial base meningiomas","volume":"39","author":"Mathiesen","year":"1996"},{"key":"b18-jns091118","series-title":"Cancer","first-page":"1473","article-title":"Radiotherapy alone or after subtotal resection for benign skull base meningiomas","volume":"98","author":"Mendenhall","year":"2003"},{"key":"b19-jns091118","series-title":"Neurosurgery","first-page":"965","article-title":"Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up","volume":"60","author":"Natarajan","year":"2007"},{"key":"b20-jns091118","series-title":"J Neurosurg","first-page":"860","article-title":"Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration","volume":"81","author":"Sekhar","year":"1994"},{"key":"b21-jns091118","series-title":"J Neurosurg","first-page":"937","article-title":"Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone","volume":"107","author":"Sindou","year":"2007"},{"key":"b22-jns091118","series-title":"Neurosurgery","first-page":"28","article-title":"Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years","volume":"58","author":"Zachenhofer","year":"2006"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/5\/article-p1072.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/5\/article-p1072.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/5\/article-p1072.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:53:15Z","timestamp":1679892795000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/5\/article-p1072.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,11]]},"references-count":22,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2010.2.jns091118","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,11]]}}}