Abstract
ObjectiveThis study aimed to establish optimal surgical strategies via reviewing the clinical outcomes of various surgical approaches for the pertroclival meningiomas (PCMs).MethodsThis retrospective study enrolled 107 patients with PCMs at the authors’ institution from year 2010 to 2020. Patient demographics, the clinical characteristics, various operative approaches, major morbidity, post-operative cranial nerve deficits and tumor progression or recurrence were analyzed.ResultsThe subtemporal transtentorial approach (STA), the Kawase approach (KA), the retrosigmoid approach (RSA) and the anterior sigmoid approach (ASA), namely the posterior petrosal approach (PPA) were adopted for 17 cases, 22 cases, 31 cases and 34 cases respectively. Total or subtotal resection was achieved in 96 cases (89.7%). The incidence of new-onset and aggravated cranial nerve dysfunction were 13.1% (14/107) and 10.4% (15/144), respectively. Furthermore, 14 cases suffered from intracranial infection, 9 cases had cerebrospinal fluid leakage, and 3 cases sustained intracranial hematoma (1 case underwent second operation). The mean preoperative and postoperative Karnofsky Performance Status (KPS) score was 80 (range 60-100) and 78.6 (range 0-100), but this was not statistically significant (P>0.05). After a mean follow-up of 5.1 years (range 0.3- 10.6 years), tumor progression or recurrence was confirmed in 23 cases. Two cases died from postoperative complications.ConclusionsFor the treatment of PCMs, it is still a challenge to achieve total resection. With elaborate surgical plans and advanced microsurgical skills, most patients with PCMs can be rendered tumor resection with satisfactory extent and functional preservation, despite transient neurological deterioration during early postoperative periods.
Highlights
Petroclival meningiomas (PCMs) refer to meningiomas that occur on the upper two-thirds of the clivus and medially to the internal auditory canal (IAC), adjacent to the major neurovascular structures, including brainstem, basilar artery, perforating arteries, and III-VII cranial nerves (CN) [1]
The exclusion criteria were as follows: [1] patients with a magnetic resonance imaging (MRI) revealing that the main body of the tumor is located on the inferior clivus or lateral wall of the IAC; [2] patients with multiple (≥2) intracranial meningiomas; [3] patients with no successful follow-up
The surgical techniques have been greatly improved in recent years, the total resection rate of PCMs remains low, and the incidence of postoperative complications is approximately 20-30% [11]
Summary
Petroclival meningiomas (PCMs) refer to meningiomas that occur on the upper two-thirds of the clivus and medially to the internal auditory canal (IAC), adjacent to the major neurovascular structures, including brainstem, basilar artery, perforating arteries, and III-VII cranial nerves (CN) [1]. Despite remarkable advances in microsurgical techniques during the past decades, many recent reports [1] still reveal a low TR rate and suggest that aggressive extirpation is often associated with severe morbidity. For this reason, some authors proposed subtotal resection (STR) followed by radiotherapy in order to preserve the neurological functions. The surgical treatment of PCMs has always been a challenge for skull base neurosurgeons due to the deep location, complex adjacent structures and their scarcity (less than 0.15% of all intracranial meningiomas) [1]. This study aimed to establish optimal surgical strategies via reviewing the clinical outcomes of various surgical approaches for PCMs based on our 107 cases
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