Abstract
Introduction:
The treatment of petroclival meningiomas remains controversial. Various surgical approaches have been described and proposed for their management. We describe our surgical experience in treating these lesions and how our management methods have changed.
Methods:
A retrospective review of craniotomies done between September 1994 and July 2005 for treatment of petroclival meningiomas was performed. Cases were also compared with previously published series from our institution dating back to 1986.
Results:
A total of 63 cases were reviewed. Approaches utilized included combined petrosal approaches (39%), standard retrosigmoid (RS) craniotomy with or without some degree of petrosectomy (69%), orbitozygomatic (OZ) craniotomy with or without anterior petrosectomy (8%), and combined OZ-RS approaches (23%). A majority of the combined petrosal approaches were performed before 1994 (72%). The percentage of cases with gross total resection was significantly higher in the combined petrosal group (68% vs. 43%) as was the complication rate (64% vs. 36%). There were no deaths in any of the groups. There was no significant difference in progression-free survival at 4.2 years' mean follow-up (84% vs. 98%). No patients treated with stereotactic radiosurgery developed progression.
Conclusion:
The utilization of combined petrosal approaches in the treatment of petroclival meningiomas leads to greater rates of complete resection while increasing the rates of morbidity. Progression-free survival remains excellent in both groups. The availability of radiosurgery as an adjunct to therapy has led to a reduction in the utilization of aggressive resection and combined approaches in favor of minimizing patient morbidity.