Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review.

Abstract

OBJECTIVE:

We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time.

METHODS:

Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression.

CONCLUSION:

Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

• Authors: Nicholas C Bambakidis, U Kumar Kakarla, Louis J Kim, Peter Nakaji, Randall W Porter, C Phillip Daspit, Robert F Spetzler
• Journal: Neurosurgery (Neurosurgery) Vol. 61 Issue 5 Suppl 2 Pg. 202-9; discussion 209-11 (Nov 2007) ISSN: 1524-4040 [Electronic] United States
• PMID: 18091234 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cranial Fossa, Posterior (surgery)
• Female
• Humans
• Male
• Meningeal Neoplasms (surgery)
• Meningioma (surgery)
• Middle Aged
• Neurosurgical Procedures
• Retrospective Studies
• Skull Base (surgery)
• Skull Base Neoplasms (surgery)