Mellal, Amine

Abstract The retrosigmoid approach (RSA) is considered the standard surgical choice to address a neurovascular conflict involving the trigeminal nerve. The subtemporal transtentorial approach (STA) represents the main alternative. We describe here the mini-invasive anterior petrosal intertentorial approach with a view to reduce complications associated with the standard STA. Mini-invasive anterior petrosal intertentorial approach (M-APIA) was described for a case of refractory trigeminal neuralgia. This approach includes a very limited amount of drilling of the petrous ridge to expose the posterior fossa dura and the superior petrosal sinus to facilitate the subsequent tentorial peeling. Tentorial peeling enables to develop an intertentorial plane between the temporal tentorial leaf (TTL) and the posterior fossa tentorial leaf (PFTL). A linear incision over the posterior fossa dura and the PFTL offers a wide exposure of the neurovascular conflict. M-APIA enables to expose the root entry zone (REZ) of the trigeminal nerve without exposing the temporal lobe or the cerebellum. M-APIA can be considered as a safe alternative to the RSA or STA for trigeminal microvascular decompression (MVD), especially for select cases. Additional studies are needed for a better understanding of its advantages and disadvantages.

Background/Objectives: Spinal astrocytomas (SA) represent 30–40% of all intramedullary spinal cord tumors (IMSCTs) and present significant clinical challenges due to their aggressive behavior and potential for recurrence. We aimed to pool the evidence on SA and investigate predictors of regrowth or recurrence after surgical resection. Methods: A systematic review and meta-analysis were conducted on peer-reviewed human studies from several databases covering the field of SA. Data were collected including sex, age, tumor location, extent of resection, histopathological diagnosis, and adjuvant therapy to identify predictors of SA recurrence. Recurrence was defined as failure of local tumor control or regrowth after treatment. Results: A total of 53 studies with 1365 patients were included in the meta-analysis. A postoperative deterioration in neurological outcomes, as assessed by the modified McCormick scale, was noted in most of the patients. The overall recurrence rate amounted to 41%. On meta-analysis, high-grade WHO tumors were associated with higher odds of recurrence (OR = 2.65; 95% CI: 1.87, 3.76; p = 0.001). Similarly, GTR was associated with lower odds of recurrence compared to STR (OR = 0.33; 95% CI: 0.18, 0.60; p = 0.0003). Sex (p = 0.5848) and tumor location (p = 0.3693) did not show any significant differences in the odds of recurrence. Intraoperative neurophysiological monitoring was described in 8 studies and adjuvant radiotherapy in 41 studies. Conclusions: The results highlight the significant importance of tumor grade and extent of resection in patient prognosis. The role of adjuvant radiotherapy remains unclear, with most studies suggesting no differences in outcomes, with limitations due to potential confounders.