gms | German Medical Science

Objective: Petroclival meningiomas represent a challenge for the neurosurgeon because of the close relationship between the tumor, the basilar artery and its branches and the cranial nerves (CN), and the often large size before coming to attention. As petroclival meningiomas are infrequent, large surgical series are warranted to answer the questions of suitable approaches (standard versus skull base), clinical outcomes especially in terms of CN function, surgery-associated complications, and radicality and recurrency. After having operated 43 patients, we feel encouraged to report our results.

Methods: Forty-three patients (35 women/8 men, mean age 55 years) underwent microsurgical removal of a petroclival meningioma under electrophysiological monitoring. The clinical files of these patients were retrospectively reviewed with special focus on pre- and postoperative symptoms, surgical approach, surgery-related complications, radicality and recurrence.

Results: The most common preoperative symptoms were CN V dysfunction (hypesthesia) (n=16), followed by hypacusis (n=11) and unsteady gait (n=11). The by far most common approach was the standard retrosigmoid approach (n=28), followed by the anterosigmoid-temporal approach (n=8). In less than half of the patients (n=21), complete resection was not performed / not intended because of tumor spread into the cavernous sinus. New facial paresis occurred in 8 patients and persisted in 5 (11.6%), while other permanent CN dysfunctions were only occasionally seen. Two brain stem infarctions occurred, leading to death in 1 patient (mortality rate 2.3%) and severe morbidity in the other. In 7 patients, adjuvant radiosurgery/radiotherapy was performed. A recurrence/regrowth was seen in 4 patients (9.3%).

Conclusions: Using a more conservative surgical approach not aiming at radical resection in every case, good clinical outcomes with a comparatively low rate of new CN deficits can be achieved with an acceptable recurrence rate. A non-skull base approach often is sufficient for tumor removal, which might have contributed to the low surgery-associated complication rate.