Petroclival meningioma - An attempt to define the role of skull base approaches in their surgical management

BACKGROUND Petroclival meningiomas represent a difficult surgical challenge. The intro duction of modern techniques of skull base surgery has stimulated the inter est of the neurosurgical community in the surgical management of these lesi ons, although very good results have been obtained by experienced neurosurg eons in cases of petroclival meningioma operated using traditional surgical approaches. METHODS Thirty-one cases of petroclival meningioma have been operated on during a 4 -year period using two different philosophies as far as the approach. Group A patients (13 cases) have been operated on using mostly either a sub-temp oral transtentorial or a retrosigmoid approach. Group B patients (18 cases) have been managed using a lateral skull base approach, either the anterior trans-petrosal or the presigmoid approach. Translabyrinthine/transcochlear approaches have been used occasionally. RESULTS Tumor dissection and removal seemed to be easier in skull-base operated pat ients. However, operations take longer and surgical complications such as c erebrospinal fluid leak and hearing loss were increased. Radical tumor remo val could be achieved in an equal percentage of cases of both groups (77% v s 83%). The early postoperative course was more favorable in group B patien ts. However, late permanent morbidity appeared to be similar in the two gro ups of patients. CONCLUSIONS Skull base approaches facilitate tumor dissection and removal at the expens e of increased surgical complications. However, the widened surgical field and increased angle of approach that the techniques of skull base surgery m ay offer can play a significant role in the removal of sizeable, infiltrati ve. and/or recurrent petroclival meningiomas.