PETROCLIVAL MENINGIOMAS - SURGICAL EXPERIENCE IN 109 CASES

The surgical removal of petroclival meningiomas has historically been associated with a high incidence of morbidity and mortality. The 109 c onsecutive patients included in the present retrospective study repres ent a combined series of tumors operated on by the four authors during a period from 1980 to 1992. The series is composed of 40 men and 69 w omen ranging in age from 25 to 75 years (mean 51 years). Surgical appr oaches to tumors in this series included simple retromastoid (60 cases ), combined supra- and infratentorial petrosal (22), transtemporal (pr imary transsigmoid retrolabyrinthine, translabyrinthine, or transcochl ear (12)), subtemporal(11), and frontotemporal transcavernous (eight). Gross-total removal was achieved in 75 patients (69%). Recurrence or progression of disease occurred in 14 patients (13%) over a 6.1-year m ean follow-up period, and it was found within the cavemous sinus in 12 of these cases. Four recurrent cases demonstrated histological compat ibility with malignant meningioma. Perioperative death occurred in fou r patients, and there were 56 significant complications in 35 other pa tients. Review of this series, with the attendant complications, has f acilitated the authors' decision-making when considering the risk of g ross-total removal in selected patients with asymptomatic cavernous si nus invasion or tumor adherent to the brainstem.