gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Petroclival meningiomas: The role of magnetic resonance imaging in the prediction of tumor resectability and surgical outcome.

Meeting Abstract

  • Ariyan Pirayesh Islamian - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • Ioannis Petrakakis - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • Joachim K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • Makoto Nakamura - Klinik für Neurochirurgie, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.15.06

doi: 10.3205/14dgnc211, urn:nbn:de:0183-14dgnc2114

Published: May 13, 2014

© 2014 Islamian et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Despite technical advances in the field of cranial base surgery, petroclival meningiomas (PCM) still pose a formidable surgical challenge. The extent of resection and postoperative morbidity is significantly determined by tumor consistency, tumor-brain adhesion and infiltration of vital structures. The purpose of this study was to identify specific tumor features on MRI predicting the microsurgical effort required during surgery and the general outcome.

Method: A retrospective analysis of 18 cases of PCM operated in our department from 2007 to 2013 was conducted with special emphasis on tumor extension, signal intensity in different MRI sequences, existence of peritumoral edema, and tumor-brain interface. These findings were correlated with the extent of resection and postoperative morbidity.

Results: Patients were aged 51–75 years (mean: 63 ± 7 years) with female predominance (12 women, 6 men). Average tumor size was 3.7 ± 1,5 cm (range: 1.4–6.3 cm); Cavernous sinus extension was seen in 10 patients, Meckel’s cave was infiltrated in 15 patients. Leading symptoms were predominantly pertaining to the vestibulocochlear (vertigo/hypacusis), the trigeminal (facial numbness/pain) or abducens nerve (diplopia) with mean symptom duration of 15 months (range: 1–128 months). Mean preoperative Karnofsky performance scale (KPS) was 80%. Surgical routes included either a frontotemporal craniotomy with subtemporal approach extended by an anterior petrosectomy, or a restrosigmoid approach with extension to Meckel’s cave through an intradural suprameatal approach. Gross total removal was achieved in five patients. Three of 13 patients who had undergone subtotal tumor removal were treated with radiation therapy subsequently. The mean postoperative KPS was 60% with duration of follow-up ranging 3–36 months (mean: 18 months). Low signal intensity compared to brain parenchyma on T2WI / FLAIR sequences was predictive for a firm tumor, whereas irregular tumor surface, absence of an arachnoidal cleavage plane and peritumoral edema correlated with a high degree of tumor-brain adhesion encountered during surgery.

Conclusions: Tumor features on MRI can predict resectability of PCM. Evidence of infiltrative tumor growth, peritumoral edema at the brainstem and firm tumor consistency correlate with higher postoperative morbidity (KPS 50 vs.70).