Surgical Management and Outcomes of Petroclival Meningiomas: Series of 17 Patients

Introduction: Petroclival meningiomas remain one of the most challenging skull base tumors. Combinations of microsurgical and radiosurgical options became one of the most reasonable strategy for these patients.

Methods: Between 2000 and 2013, 17 patients underwent surgical treatment for petroclival meningiomas. Mean age was 49.3 years. Retrosigmoid approach with tentoriotomy was performed in 11 patients and suprameatal extension was used in 6 patients. In five cases, retrosigmoid approach was combined with a subtemporal and orbitozygomatic approach.

Results: Headache, balance disturbances, diplopia, facial pain, and numbness were the most common clinical manifestation. Preoperative cranial nerves (CN) involvement: III–VI in three (18%) and V nerve in eight (47%) patients. Mean tumor size was 4.39 cm. Gross-total resection was achieved in seven patients (41%). Two patients with residual tumor were treated with radiosurgery. Recurrence or tumor progression was noted in two patients (12%). New postoperative CN disturbances were observed in 11 patients (65%) and CNs III, IV, and VI were presented in six patients, CN V in five, CN VII in three, and CN VIII in two patients. In our series, IV CN dysfunction was the most common (35%). In six patients, CN dysfunction was transient and five patients had permanent dysfunction. At the time of discharge, 82% of patients had Glasgow Outcome Scale Scores 4 and 5, in 1 year 89% of patients were functionally independent.

Conclusion: Tendency for surgical radicality increases CN morbidity. Cranial nerves morbidity remains the main cause of disability in this group of patients. The residual part of the tumor with aggressively involved CN should be considered as unremovabale.