gms | German Medical Science

Objective: The neurosurgical treatment of petroclival and sphenopetroclival meningiomas is complex and challenging. Depending on the size and tumor extension surgical management can be very different. Therefore individualized surgical approaches, sometimes multi-staged, are necessary.

Methods: We present our clinical experience with primary petroclival and phenopetroclival meningiomas, that were treated in our institution between 11/2003 and 03/2017. The distribution of clinical parameters, outcome data as well as management algorithms are described.

Results: Forty-four petroclival and twenty-four sphenopetroclival meningiomas were analyzed. A two-staged surgery was done for 10/24 sphenopetroclival and for 1/44 petroclival meningiomas. The extent of resection was Simpson grade 4 for all sphenopetroclival meningiomas, mainly due to cavernous sinus invasion, while some petroclival meningiomas could be resected with more radicality (13/44 Simpson grade 1-3). Atypical meningiomas were more often diagnosed in sphenopetroclival meningiomas (20.8% compared to 4.6%, p=0.0347). A mean follow-up of 43.26 months showed a recurrence rate of 31.6% for petroclival and 72.2% for sphenopetroclival meningiomas, respectively (p=0.0043). A significant prognostic difference in favor of petroclival compared to sphenopetroclival meningiomas was also observed in the Kaplan-Meier analysis (p=0.0406).

Conclusion: The outcome of the surgical treatment of petroclival and sphenopetroclival meningiomas shows marked differences in favor of petroclival tumor location due to microsurgical accessability and tumor biology. An individualized approach to the neurosurgical management of petroclival and sphenopetroclival meningiomas is important.