Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center.

Dingkang Xu,Fuyou Guo,Zhihua Li,Yazhou Lin,A Bao Guo,Nana Wang,Qiang Gao,Weidong Zang,Huiping Jin,Fang Wang

doi:10.3389/fneur.2021.627736

Abstract

Objectives: We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype.Methods: Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes.Results: The subtemporal (33.33%), retrosigmoid (16.67%), and Kawase approaches (50%) were used for the UC type. Simpson I/II resection was achieved in 46.66% of patients with the Kawase approach. Significant differences were found between the other two approaches (P = 0.044) and in the follow-up Karnofsky performance scale (KPS) scores (P = 0.008). The subtemporal (60%) and Kawase approaches (40%) were used for the CS type; neither approach achieved Simpson I/II resection. The retrosigmoid (25.81%) and Kawase approaches (74.19%) were used for the TE type. The Simpson I/II resection rates of the two approaches were 55.55 and 86.95%, respectively, and a significant difference was observed between them (P = 0.039). The retrosigmoid (43.75%) and Kawase approaches (56.25%) were used for the PA type. The Simpson I/II resection rates of the two approaches were 31.25 and 50%, respectively. The resection degrees of the two approaches and the KPS scores at follow-up were significantly different (P = 0.034).Conclusion: The individual microsurgical approaches adopted for the various PM tumor subtypes can provide maximal safe resection and good KPS scores. The Kawase approach is more suitable for PM, especially for UC- and PA-type PM tumors.

Highlights

Petroclival meningioma (PM) is a rare benign tumor that occurs on the skull base
The duration of symptoms ranged from 10 days to 156 months, and 30 patients had hypertension, diabetes or chronic respiratory disease
Of all PM cases, the upper clivus type (UC) type accounted for 29.4% (30 cases), the cavernous sinus (CS) type accounted for 24.5% (25 cases), the TE type accounted for 30.4% (31 cases), and the petrous apex (PA) type accounted for 15.7% (16 cases) (Table 1)

Summary

Introduction

Petroclival meningioma (PM) is a rare benign tumor that occurs on the skull base It originates at the upper two-thirds of the clivus medial to the fifth cranial nerve (CN V) and accounts for 2% of posterior fossa meningiomas [1,2,3,4]. The incidence of permanent cranial nerve injury has ranged from 20.3 to 76%, and the proportion of total tumor resection has varied from 20 to 85% [9,10,11]. It has become the common goal of all neurosurgeons to select the appropriate surgical approach according to the invasive site of the tumor base and to reduce postoperative neurological impairments in the patient and improve his/her quality of life while removing as much of the tumor as possible

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