BACKGROUND We report the clinical, radiological, and surgical findings of p
atients with posterior fossa meningiomas surgically treated at our institut
ion over the last 6 years.
METHODS We reviewed 161 consecutive cases of posterior fossa meningiomas op
erated on between April 1993 and April 1999 at The George Washington Univer
sity Medical Center.
RESULTS There were 128 female and 33 male patients (mean age 47 years, rang
e of 10-81 years). Meningiomas were classified as petroclival (110 cases),
foramen magnum (21 cases), cerebellar hemispheric, lateral tentorial (14 ca
ses), cerebellopontine angle (9 cases), and jugular foramen (7 cases). Mean
tumor equivalent diameter (TED) = (D1XD2XDE)(1/3) was 3.1 cm (range of 0.5
3-8.95). Head pain (50% of cases) and disturbance of gait (44%) were the mo
st common presenting symptoms, and cranial neuropathies the most common neu
rological signs on admission. Mean preoperative performance status (Karnofs
ky scale) was 80.2 (range 40-100). Surgical approaches to these tumors incl
uded partial labyrinthectomy petrous apicectomy, fronto-temporal/fronto-tem
poral orbitozygomatic osteotomy, retrosiginoidal, extreme lateral, transpet
rosal, and combined. In 38 cases a staged procedure was performed. Gross-to
tal resection was achieved in 57% of patients, and subtotal/partial in 43%.
Surgical mortality was 2.5% and complications were encountered in 41% of p
atients. Postoperative CSF leak occurred in 22 cases (13.6%). The mean foll
ow-up was 19 months, ranging from 0.2 to 63.6, and the mean performance sta
tus of patients with a follow-up of at least 12 months was 77 (range of 40-
100). Recurrence or progression of disease was found in 13.7% of cases (fol
low-up 2 years or more).
CONCLUSION Our experience suggests that although posterior fossa meningioma
s represent a continuing challenge for contemporary neurosurgeons, such tum
ors may be completely or subtotally removed with low rate of mortality and
acceptable morbidity, allowing most of these patients to achieve a good out
come in a long-term follow-up. (C) 2001 by Elsevier Science Inc.