Petrous Face Meningiomas: Classification, Presentation Syndromes, and Surgical Outcomes

Background Petrous face meningiomas, located in the cerebellopontine angle, are surgically challenging skull base tumors given their close proximity to the cranial nerves, brainstem, and posterior fossa vasculature. Tumors in different locations along the petrous face present with specific clinical syndromes. The objective of the current study is to present our surgical outcomes after resection of petrous face meningiomas and develop a classification for petrous face meningiomas based on their anatomic location and clinical presentation.

Methods A retrospective chart review of 2,120 meningiomas resected at the authors' institution from 1991 to 2014 was performed, and 51 isolated petrous face meningiomas were identified. Tumors were classified based on their location along the petrous face, with tumors anterior to the internal auditory canal being classified as anterior, those superior or arising adjacent to the IAC being classified as middle, and those arising between the IAC and sigmoid sinus as posterior petrous face. Surgical outcomes and complications were analyzed with univariate and multivariate regression.

Results We identified 51 patients, with mean follow-up of 115 months. The majority of tumors were WHO Grade I (n = 50), with one WHO Grade II tumor. Tumor location was anterior (21%), middle (13%), posterior (52%), and overlapping territories (12%). Mean tumor diameter was 3.2 cm (0.8–6.2 cm). Anterior location was significantly associated with facial pain/numbness on presentation (p < 0.0001). Middle petrous face location was significantly associated with hearing loss/vestibular dysfunction (p = 0.003). Posterior petrous location was significantly associated with headache (p = 0.007), hydrocephalus (p = 0.005), and vertigo (p = 0.02) on presentation. The gross total resection rate was 63%, near total was 13%, and subtotal was 24%. The recurrence rate was 9.8%, and all recurrences were treated with radiation therapy. The complication rate was 25%. Age, location, or approach did not predict complications.

Conclusion Petrous face meningiomas present with distinct clinical syndromes that can be classified into anterior, middle, and posterior locations. Tumor size at presentation increases for tumors located more posteriorly. Resection of these tumors is associated with a significant rate of complications, but a low rate of recurrence that can be managed with radiotherapy.