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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Microsurgical treatment and classification of petroclival meningioma: Experiences in 471 patients at a single institute for 18 years

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  • Jie Tang - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China
  • Zhen Wu - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China
  • Guijun Jia - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China
  • Liwei Zhang - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China
  • Xinru Xiao - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China
  • Junting Zhang - Department of Neurosurgery, Beijing Tiantan Hospital,Capital Medical University, Beijing, P R China

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.18.04

doi: 10.3205/13dgnc157, urn:nbn:de:0183-13dgnc1570

Published: May 21, 2013

© 2013 Tang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Although there has been great development in the anatomical understanding and operative techniques for skull base tumors, controversy still exists regarding the optimal surgical strategies for the petroclival meningioma (PCM). Different subtypes of PCM cause variation of symptoms and surgical approaches according. The authors reviewed 471 consecutive cases of PCM operated between Oct 1992 and Mar 2010 in the Division of Skull Base, Department of Neurosurgery at Beijing Tiantan hospital. The surgical strategy and neuroimaging classification of PCM is established for surgical plan.

Method: A total of 471 consecutive cases of PCM between Oct 1992 and Mar 2010 in Beijing Tiantan hospital were reviewed. The data including the patients’ preoperative symptoms, operation note, pre and post neuroimaging, assessment of quality of life and neurologic dysfunction, etc.

Results: There were 327 female and 144 male patients. A Six subtype classification system was established based on tumor origin and extension direction. Petroclival meningioma were classified as 6 subgroups including petrous apex (35 cases), cavernous sinus (40 cases), sphenopetrosal (56 cases), petroclival and cavernous sinus (75 cases), cerebellopontine angle (33 cases), clivus (62 cases) and extensive (170 cases). Cranial nerves palsy (58%) was the most common symptoms. The surgical approach was chosen according the classification of the tumor location and size. Subtemporal transtentorial approach was performed in 172 cases, presigmoidal approach in 165 cases, retrosigmoidal approach in 46, frontotemporal approach in 40, Kawase approach in 36 and other approach in 12 cases. Gross total resection was achieved in 84.0% of patients. Surgical mortality was 2%.

Conclusions: Our experience suggests that the classification of six subtypes of PCM is practical and helpful for the preoperative surgical plan. Although the mortality of PCM decreased significantly, the neurological deficits are still big challenge for microsurgical resection of PCM. Brainstem peritumoral edema, vital arteries encasement, tumor size larger than 4 cm in diameter is independent risk factors for outcome.