Efficacy of resecting petroclival meningiomas via different surgical approaches

Abstract

Objective To investigate the surgical approaches of effective resection of petroclival meningiomas. Methods Thirty-six patients with petroclival meningioma admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2009 to January 2014 were enrolled retrospectively. When a major part of the tumor was located in supratentorium, in particular the invasion of the cavernous sinus and broking into the middle cranial fossa, resected it via zygomatic-frontal-temporal approach; when a major part of the tumor was located in posterior fossa or only invasion of Meckel capsule, even a small part of tumor invasion of the cavernous sinus, reseted it via retrosigmoid approach; for patients with huge tumor and invasion of middle or posterior fossa at the same time, the supratentorial and infratentorial tumors were resected by stages in combination with 2 approaches. Results The tumors of 21 patients were resected via zygomatic-frontal-temporal approach, those of 12 patients were resected via retrosigmoid approach, and those of 3 patients were resected by stages in combination with 2 approaches. Total, subtotal, near-total, and partial resection of tumors were achieved in 16, 14, 5, and 1 cases, respectively. They were followed up for 6 to 60 months after discharge (mean, 32.0±19.6 months). Thirty-three patients recovered well and 3 recovered poorly. Twelve patients (33.3%) had postoperative complications, including 3 had oculomotor nerve paralysise, and 2 of them recovered; 5 had trochlear nerve dysfunction, 2 had facial numbness, and 1 had tinnitus. They had different degrees of recovery during the follow-up period. One patient had temporal lobe edema, and he was improved after conservative treatment. No cerebrospinal fluid leakage and death case were observed. Four patients had tumor recurrence, 3 had tumor residue, and 4 patients with recurrence were treated with Gamma knife. Conclusion Resection of petroclival meningioma via different approaches may achieve a satisfactory effect. Key words: Meningioma; Skull base neoplasms; Petroclival region; Surgical approach; Treatment outcome