gms | German Medical Science

Objective: The purpose of this retrospective study was to analyze the postoperative outcome of petroclival meningiomas.

Methods: A total of 93 petroclival and prominently clival meningomas underwent 111 operations between Jan. 1994 and Dec. 2010 and were amendable for follow-up including regular ambulatory visits and a questionnaire.

Results: The median age of the 74 women and 19 men was 69.1 years. The patients most commonly presented with headaches, trigeminal pain or dysaesthesia, dizziness, ataxia, unsteadiness in more than 50% of cases, in 25–30% with hearing loss, double vision or visual disturbances. The median tumor volume was 56 cm³. The most frequent histology subtypes were meningothelial (42%), transitional (18%), and 22% with atypical meningiomas WHO°II. Intraoperative radicality was in 32 Simpson grade 2, 4 grade 3, and 17 grade 4. Eight patients underwent two-staged operations. There was one perioperative death unrelated to a neurological deficit. 7% suffered from CSF leak treated with lumbar drainage or open revision. Two post-operative VP-shunt placements, two tracheostomies, and two facial nerve reconstructions were necessary. Eight patients received radiation therapy of a recurrence/progression. Post-OP morbiditiy was improved with regards to hearing loss (24% pre-op, 18% post-op), trigeminal symptoms (28% pre, 48% immediate post-op, 33% last exam), overall double vision did not change significantly from pre-op to post-op. Facial nerve paresis occurred in 28% compared to 19% pre-op, most of which resolved within a few months. Operative radicality was associated with location, medial structure involvement, and size.

Conclusions: Petroclival meningiomas represent an entity that has a higher than usual treatment related morbidity than meningiomas in other tumor locations. Due to the complexity of the proximate anatomy, operative approaches and intra-operative findings, these tumors remain a neurosurgical challenge.