gms | German Medical Science

Objective: The management of petroclival meningiomas (PM) remains notoriously difficult due to their close association to neurovascular structures and complex anatomy. We analyzed surgical and functional outcome of a consecutive series of patients.

Methods: We reviewed patient charts and imaging data of patients with a PM resected at our institution and compared surgical and functional outcomes between subgroups stratified by surgical approach.

Results: A consecutive cohort of 64 patients from 2006 to 2018 were included, of which 67.2% were female with mean age was 55 years (range 21 – 84). Follow-up data were available for 68.8% and reached a mean 42.3 months (range 1 – 129) with a median 28.5 months. Most tumors were WHO grade I (95.3%) with an average size of 37 ± 15 mm. Infiltration of the cavernous sinus was observed in 53.1% of cases and the lesion reached the brain stem in 82.8% of cases. Preoperative cranial nerve palsy was observed in 73.4%, of which trigeminal neuropathy (42.2%), hearing loss (32.8%) and impairment of vision (18.8%) were the most common. A retrosigmoid approach was employed in 78.1% of cases, a pterional in 15.6%, combined petrosal in 3.1% and transnasal as well as subtemporal in 1.6% each. Fifteen cases (23.4%) were resected in a two-staged fashion. Gross total resection (GTR) defined as Simpson grades I and II was achieved in 71.0%, with surgical complications in 21.3% of cases most commonly constituting meningitis (6.3%). Postoperatively, 87.5% of patients had cranial nerve palsy, of which 63.6% had improved or resolved on last follow up. Trigeminal neuropathy had the highest resolution rate with 15.6%, while visual impairment only improved in 1.6% and hearing loss in 4.7%. Achieving GTR was not significantly associated with higher rates of surgical complications (p=.288) or postoperative cranial nerve palsy (p=.842). Tumor progression was observed in 15.9% of patients after a mean 102 months.

Conclusion: Despite the substantial technical challenge, resection of PMs represents the mainstay of tumor control with favourable resolution of perioperatively prevalent cranial nerve palsies.