Evaluation of microsurgical removal of petroclival meningioma

Abstract

Objective To evaluate the microsurgical treatment strategy of petroclival meningioma, the risk factors of tumor resection and the prognosis of the patients in order to improve the surgical therapeutic effects. Methods The clinical and follow-up data were retrospectively analyzed in a consecutive series of 71 cases with petroclival meningiomas who received microsurgical resection between July 1991 and April 2010. Results The study consisted of 71 patients with a female-to-male ratio 2.9 and mean age (47.0±11.2) years. The mean duration of symptom was (32.5±3.0) months and the mean diameter of tumor was 44.4 mm. The retrosigmoid (transtentorial) approach was mainly chosen (65 cases, 91.5%) in the study. Three cases were treated visa transpetrosal presigmoid approach and 3 cases with other kinds of approaches. The gross total removal (GTR) reached in 48 cases (67.6%). The subtotal removal was achieved in 10 cases and partial removal in 13 cases.Forty-seven cases (72.3%) reached GTR via retrosigmoid (transtentorial) approach. One case (1.4%) died postoperatively. The mean of postoperative KPS was (73.2±15.6). Sixty-four cases were followed-up with a mean period of (60.7±47.5) months. The mean KPS at the last visit was (83.2±13.4). Recurrence and progression were identified in 6 and 8 cases respectively and 7 cases died during the follow-up period. In the follow-up patients, the overall survival rate was 100% at 6 months, 91.3% at 1 year, 89.2% at 3 years, 88.5% at 5 years and 85.7% at 10 years. The tumor texture (P=0.092), subtype (P=0.088), depth of invasion into cavernous sinus (P=0.001) and whether to warp neurovascular structures (P=0.033) had significant correlations with the extent of tumor removal. Conclusions With regard of improving therapeutic effect and patient prognosis, adjustable approach should be chosen individually based on the different factors affecting tumor removal. Retrosigmoid (transtentorial) approach was one of the most crucial and effective approaches for the removal of petroclival meningioma. Key words: Petroclival meningioma; Microsurgery; Surgical procedures, operative