Endonasal and Lateral Approaches to Petroclival Meningiomas: Comparison and Early Clinical Outcome

Abstract

Objective: Despite sophisticated transpetrosal approaches, petroclival meningioma (PCM) surgery is associated with substantial surgical morbidity. Study Design: Retrospective chart review. Methods: Retrospective review of 32 patients with PCM. Overall 11 patients underwent lateral approaches (mainly retrosigmoid approach [RSA]), 17 had midline approaches (endoscopic endonasal approach [EEA]) and 4 had a combination. Results: The average Karnofsky score (KS) at presentation was 73.8. Gross- or near-total (>90%) resection rate was 47%. The average postoperative KS was improved at 86.7. Postoperative functional improvement was significant (p < 0.001) during short-term median follow-up of 8 months (range, 1-42 months). Functional improvement was significant regardless of patient's age, tumor size, or vascular encasement. Surgical approach did not influence the clinical outcome, suggesting proper selection. Complications included new CN palsies (43.8%) affecting mainly the abducens nerve; only one patient developed lower CN palsies (3.1%). Other complications included postoperative hydrocephalus (15.6%) and CSF leak (28.1%). There were no strokes; one patient died in the perioperative period (3.1%). Conclusion: Less-invasive approaches, including appropriately selected RSA and EEA, are effective alternatives to transpetrosal approaches for the management of PCM. With the goal of symptom relief rather than GTR, significant early clinical improvement can be achieved with limited devastating surgical complications.