Surgical Management of Petroclival Meningiomas: Selection of Operative Approaches and Complication Avoidance, Results in 350 Cases

Abstract

Meningiomas arising from the petroclival region remain the most difficult and challenging surgical problem in neurosurgery due to the involvement of multiple cranial nerves and vascular structures as well as the frequent association of high vascularity, fibrous hard consistency, and adhesion to the vital structures. Uniformly pursuing total resection may not be justified. Surgeons must tailor the resectability and operative approaches in terms of minimizing postoperative neurological morbidity. From 1980 to the end of 2006, we operated on 350 cases of petroclival meningiomas. Micro-operative technical advances in skull base approaches, refinement of microsurgical approaches, and high-resolution diagnostic neuroimaging methods have contributed to improved morbidity and mortality rates. We published the initial surgical results in 109 cases operated upon between 1980 to May 1992 in the Journal of Neurosurgery. We summarized the second series between June 1993 and the end of 2006 with 241 petroclival meningiomas with much-improved mortality and morbidity. We wish to discuss selection of the most appropriate operative approach, the decision of resectability and radicality, and careful and meticulous operative techniques for complication avoidance in this presentation.