The extended pterional transtemporal transtentorial approach for large and giant petroclival meningiomas

Abstract

Objective To study the surgical techniques and effectiveness of the extended pterional transtemporal transtentorial approach for the resection of large and giant petroclival meningiomas. Methods Some modifications were made to the pterional approach by liberation and retraction of temporal pole, incision of tentorium and petrous apicectomy to provide effective corridor to the sphenopetroclival region. Thirty-three patients with large(14 cases) and giant meningiomas(19 cases) were analyzed retrospectively who received the extended pterional transtemporal transtentorial approach from January 2000 to March 2012. The neurological dysfunction, resection rate and quality of life were analyzed. Results Gross total resection was achieved in 15 patients (45%), subtotal in 17(52%) and partial in 1(3%). One patient died of hyperthermia and electrolyte disorder postoperatively. Twenty-eight patients were followed-up for mean 37.8 months (range 4-135 months). Three patients had tumor recurrence. Karnofsky Performance Scale showed the outcome of prognosis was improved in 11 patients (39%), unchanged in 12 (43%) and deteriorated in 5(18%). There was no statistically significance according to Karnofsky Performance Scale compared with that of preoperation. Conclusions The extended pterional transtemporal transtentorial approach was an effective approach for the resection of large and giant petroclival meningiomas, especially for giant meningiomas that predominantly occupied the middle fossa and extended to the supratentorial region. Key words: Petroclival meningioma; Skull base; Microsurgery