Petroclival meningioma. An attempt to define the role of skull base approaches in their surgical management.

BACKGROUND

Petroclival meningiomas represent a difficult surgical challenge. The introduction of modern techniques of skull base surgery has stimulated the interest of the neurosurgical community in the surgical management of these lesions, although very good results have been obtained by experienced neurosurgeons in cases of petroclival meningioma operated using traditional surgical approaches.

METHODS

Thirty-one cases of petroclival meningioma have been operated on during a 4-year period using two different philosophies as far as the approach. Group A patients (13 cases) have been operated on using mostly either a subtemporal transtentorial or a retrosigmoid approach. Group B patients (18 cases) have been managed using a lateral skull base approach, either the anterior transpetrosal or the presigmoid approach. Translabyrinthine/transcochlear approaches have been used occasionally.

RESULTS

Tumor dissection and removal seemed to be easier in skull-base operated patients. However, operations take longer and surgical complications such as cerebrospinal fluid leak and hearing loss were increased. Radical tumor removal could be achieved in an equal percentage of cases of both groups (77% vs. 83%). The early postoperative course was more favorable in group B patients. However, late permanent morbidity appeared to be similar in the two groups of patients.

CONCLUSIONS

Skull base approaches facilitate tumor dissection and removal at the expense of increased surgical complications. However, the widened surgical field and increased angle of approach that the techniques of skull base surgery may offer can play a significant role in the removal of sizeable, infiltrative, and/or recurrent petroclival meningiomas.