Surgical strategies and techniques of petroclival meningiomas by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches

Abstract

Objective To summary the microsurgical strategies and techniques of petroclival meningiomas by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches to raise the removal rate and improve the prognosis. Methods The clinical data of consecutive 26 patients with petroclival meningiomas, admitted to our hospital from January 2011 to December 2015 and accepted microsurgical treatment, were reviewed retrospectively; 7 of them were guided by neuronavigation, 8 were performed under neuroelectrophysiological monitoring, and 11 were guided by neuronavigation combined intraoperative MRI or neuroelectrophysiological monitoring. The operative methods and techniques, tumor resection rate and Karnofsky performance scale (KPS) scores before and after operation were analyzed. Results Of all patients who underwent surgical treatment by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches, gross total tumor resection (Simpson I-II) was achieved in 23 patients (88.5%), subtotal (Simpson III-IV) in 3 patients (11.5%). Six patients (23.1%) had cranial nerve deficit postoperatively. No mortality which related with operation was noted. Patients were followed up for 3-35 months, 23 patients had KPS scores ≥70, and 3 patients had KPS<70; no tumor recurrence or progression was noted. Conclusion The trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches are safe, effective and minimally invasive for resection of petroclival meningiomas; mastering the operation strategies and intraoperative skills is conducive to improve the efficacy of surgery. Key words: Petroclival meningioma; Minimally invasive surgical approach; Subtemporal keyhole approach; Retrosigmoid keyhole approach; Surgical technique