Partial Labyrinthectomy Petrous Apicectomy for Large Petroclival Meningiomas: Hearing Preservation Rate and Quality-of-Life Outcomes

Background: The petroclival region is generally considered a challenging area to be accessible surgically due to the depth and the surrounding delicate neurovascular structures. Various operative techniques have been described for resection of tumors in this area including retrosigmoid, presigmoid retrolabyrinthine and translabyrinthine approaches. The partial labyrinthectomy petrous apicectomy (PLPA) approach involves removal of the superior and posterior semicircular canals following mastoidectomy, with preservation of the endolymph to maintain hearing. This is followed by skeletonization of the internal acoustic meatus and drilling of the petrous apex to increase exposure. Removal of the two semicircular canals increases the working angle whilst preserving hearing. We present hearing preservation rate and long-term quality of life outcomes for patients who underwent PLPA approach for removal of petroclival meningiomas.

Methods: We carried out a retrospective review of all patients who had PLPA operation for petroclival meningoma resection between 2002 and 2024 at a large tertiary center. We collected data on patient demography, tumor size, pre- and postoperative hearing assessment by the Otolaryngologist and formal audiometry, quality of life data using the 36-Item Short Form Survey (SF-36).

Results: Thirtyfour out of 41 patients had data available for collection (10 males, 24 females). The mean age was 53.8 years old and the average tumor size was 43.4 mm. Two patients had postoperative leak of cerebrospinal fluid (5.9%)—one resolved with the use of a lumbar drain, the other required return to theatre for repair. Majority of the patients had a World Health Organization (WHO) grade 1 meningioma, whilst six of them had a grade 2 meningioma. Six patients had poor, non-serviceable hearing preoperatively. Out of the 28 patients who had PLPA operation with the aim of preserving hearing, 9 patients did not have follow-up hearing assessment, 15 patients had preserved and serviceable hearing post-operatively, and four patients had worse hearing. Overall, the hearing preservation rate is 78.9% (15 out of 19) with an average follow-up of 14.1 months. Preoperative and postoperative SF-36 data were collected and scored for all eight domains of the physical and mental components. These were divided into short-term (up to 3 months), medium-term (3–12 months), and long-term (12–24 months) follow-up. The patients had transient reduction in the physical component scores during short-term reviews postoperatively, with subsequent improvement in all domains during medium-term and long-term follow-up.

Conclusion: In conclusion, we achieved a hearing preservation rate of 78.9% for patients who underwent PLPA operation for large petroclival meningiomas, with two patients experiencing CSF leak postoperatively. These patients achieved satisfactory quality of life on medium and long-term follow-up.

Publication History

Article published online:
07 February 2025