Download PDF
Skull Base 2010; 20(5): 337-342
DOI: 10.1055/s-0030-1253581
ORIGINAL ARTICLE

© Thieme Medical Publishers

Surgery for Petroclival Meningiomas: A Comprehensive Review of Outcomes in the Skull Base Surgery Era

Michael L. DiLuna1 , Ketan R. Bulsara1
  • 1Department of Neurosurgery, Yale University School of Medicine, Neurovascular and Skull Base Surgery Programs, New Haven, Connecticut
Further Information

Publication History

Publication Date:
27 April 2010 (online)

    Permissions and Reprints

ABSTRACT

Skull base surgery has evolved to a point that its focus is now shifting to outcome analysis. To do so for petroclival meningiomas is difficult. The rarity of the tumor, different treatment philosophies, and variations in reporting complicate the outcome analysis. With this limitation in mind, we analyzed the literature on this disease and report the combined outcomes in a unified fashion in hopes that it will serve as a starting point for further prospective analysis. Data was extracted from all available reports on MEDLINE/PubMed published in English. All studies were retrospective and uncontrolled. The majority of studies represent the experience of a single surgeon at a single institution. Of the 19 studies with detailed demographic and outcome data, no data met criteria for meta-analysis. A total of 1000 patients were reported. The mean age of the patients was 50 years. The male to female ratio is 1:3. GTR (gross total resection) was reported in 49% of patients. Thirty-four percent of patients experienced some neurological deficit in the early postoperative period (<3 months). The most common morbidities reported were cranial nerve deficits (34.4% [range: 20 to 79%]) with facial nerve injury accounting for 19%, followed by motor deficits (14%), infection rates (1.6%), CSF leaks (5%), hemorrhage (1.2%), and hydrocephalus (1%). Death within 1 year of surgery was reported for 1.4% of patients. Once considered untreatable, petroclival meningiomas can now be approached relatively safely. There, however, still remains an ~34% morbidity with the most common being cranial nerve. Despite this, >75% of patients return to independence at 1 year, many of which will resume employment. The nature of this study limits the conclusions that can be drawn; however, it provides some generalizations that may help guide patient questions regarding treatment outcomes.

KEYWORDS

Meningioma - petrous - clivus - sphenopetroclival - petroclival

REFERENCES

  • 1 Castellano F, Ruggiero G. Meningiomas of the posterior fossa.  Acta Radiol Suppl. 1953;  104 1-177
    PubMedSearch in Google Scholar
  • 2 Martínez R, Vaquero J, Areitio E, Bravo G. Meningiomas of the posterior fossa.  Surg Neurol. 1983;  19(3) 237-243
    CrossrefPubMedSearch in Google Scholar
  • 3 Nishimura S, Hakuba A, Jang B J, Inoue Y. Clivus and apicopetroclivus meningiomas—report of 24 cases.  Neurol Med Chir (Tokyo). 1989;  29(11) 1004-1011
    CrossrefPubMedSearch in Google Scholar
  • 4 Al-Mefty O, Fox J L, Smith R R. Petrosal approach for petroclival meningiomas.  Neurosurgery. 1988;  22(3) 510-517
    CrossrefPubMedSearch in Google Scholar
  • 5 Bricolo A P, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients.  Neurosurgery. 1992;  31(5) 813-828, discussion 828
    CrossrefPubMedSearch in Google Scholar
  • 6 Couldwell W T, Fukushima T, Giannotta S L, Weiss M H. Petroclival meningiomas: surgical experience in 109 cases.  J Neurosurg. 1996;  84(1) 20-28
    CrossrefPubMedSearch in Google Scholar
  • 7 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas.  Acta Neurochir (Wien). 1992;  118(1–2) 27-32
    CrossrefPubMedSearch in Google Scholar
  • 8 Seifert V, Raabe A, Zimmermann M. Conservative (labyrinth-preserving) transpetrosal approach to the clivus and petroclival region—indications, complications, results and lessons learned.  Acta Neurochir (Wien). 2003;  145(8) 631-642, discussion 642
    CrossrefPubMedSearch in Google Scholar
  • 9 Sekhar L N, Wright D C, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls.  J Neurooncol. 1996;  29(3) 249-259
    CrossrefPubMedSearch in Google Scholar
  • 10 Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M. Natural history of petroclival meningiomas.  Neurosurgery. 2003;  52(1) 55-62 discussion 62-64
    CrossrefPubMedSearch in Google Scholar
  • 11 Bulsara K R, Al-Mefty O. Skull base surgery for benign skull base tumors.  J Neurooncol. 2004;  69(1–3) 181-189
    CrossrefPubMedSearch in Google Scholar
  • 12 Dany A, Delcour J, Laine E. Meningiomas of the clivus. Clinical, radiological and therapeutic study.  Neurochirurgie. 1963;  48 249-277
    PubMedSearch in Google Scholar
  • 13 Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura T. Clivus meningioma: six cases of total removal.  Neurol Med Chir (Tokyo). 1977;  17(1 Pt 1) 63-77
    PubMedSearch in Google Scholar
  • 14 Carvalho G A, Matthies C, Tatagiba M, Eghbal R, Samii M. Impact of computed tomographic and magnetic resonance imaging findings on surgical outcome in petroclival meningiomas.  Neurosurgery. 2000;  47(6) 1287-1294 discussion 1294-1295
    CrossrefPubMedSearch in Google Scholar
  • 15 Jung H W, Yoo H, Paek S H, Choi K S. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases.  Neurosurgery. 2000;  46(3) 567-574 discussion 574-575
    CrossrefPubMedSearch in Google Scholar
  • 16 Mathiesen T, Gerlich A, Kihlström L, Svensson M, Bagger-Sjöbäck D. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas.  Neurosurgery. 2007;  60(6) 982-991 discussion 991-992
    PubMedSearch in Google Scholar
  • 17 Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: report of 24 cases.  Neurosurgery. 1989;  24(1) 12-17
    CrossrefPubMedSearch in Google Scholar
  • 18 Yasargil M, Mortara R, Curcic M. Meningiomas of basal posterior cranial fossa. In: Krayenbuhl H Advances and Technical Standards in Neurosurgery. Vol. 7. Austria; Springer-Verlag 1980: 1-115
    PubMedSearch in Google Scholar
  • 19 Cherington M, Schneck S A. Clivus meningiomas.  Neurology. 1966;  16(1) 86-92
    CrossrefPubMedSearch in Google Scholar
  • 20 Abdel Aziz K M, Sanan A, van Loveren H R, Tew Jr J M, Keller J T, Pensak M L. Petroclival meningiomas: predictive parameters for transpetrosal approaches.  Neurosurgery. 2000;  47(1) 139-150 discussion 150-152
    CrossrefPubMedSearch in Google Scholar
  • 21 Cho C W, Al-Mefty O. Combined petrosal approach to petroclival meningiomas.  Neurosurgery. 2002;  51(3) 708-716 discussion 716-718
    CrossrefPubMedSearch in Google Scholar
  • 22 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach.  Neurosurg Focus. 2005;  19(2) E7
    CrossrefPubMedSearch in Google Scholar
  • 23 Cantore G, Delfini R, Ciappetta P. Surgical treatment of petroclival meningiomas: experience with 16 cases.  Surg Neurol. 1994;  42(2) 105-111
    CrossrefPubMedSearch in Google Scholar
  • 24 Natarajan S K, Sekhar L N, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up.  Neurosurgery. 2007;  60(6) 965-979 discussion 979-981
    PubMedSearch in Google Scholar
  • 25 Bambakidis N C, Kakarla U K, Kim L J et al.. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review.  Neurosurgery. 2007;  61(5, Suppl 2) 202-209 discussion 209-211
    PubMedSearch in Google Scholar
  • 26 Levine Z T, Buchanan R I, Sekhar L N, Rosen C L, Wright D C. Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas.  Neurosurgery. 1999;  45(2) 221-230
    CrossrefPubMedSearch in Google Scholar
  • 27 Little K M, Friedman A H, Sampson J H, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients.  Neurosurgery. 2005;  56(3) 546-559 discussion 546-559
    CrossrefPubMedSearch in Google Scholar
  • 28 DeMonte F, Smith H K, Al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas.  J Neurosurg. 1994;  81(2) 245-251
    CrossrefPubMedSearch in Google Scholar
  • 29 Goel A. Extended lateral subtemporal approach for petroclival meningiomas: report of experience with 24 cases.  Br J Neurosurg. 1999;  13(3) 270-275
    CrossrefPubMedSearch in Google Scholar
  • 30 Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality.  Acta Neurochir (Wien). 1994;  129(3–4) 113-120
    CrossrefPubMedSearch in Google Scholar
  • 31 Mayberg M R, Symon L. Meningiomas of the clivus and apical petrous bone. Report of 35 cases.  J Neurosurg. 1986;  65(2) 160-167
    CrossrefPubMedSearch in Google Scholar
  • 32 Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J. Petroclival meningiomas: is radical resection always the best option?.  J Neurol Neurosurg Psychiatry. 1997;  62(4) 341-345
    CrossrefPubMedSearch in Google Scholar
  • 33 Chang S D, Adler Jr J R, Martin D P. LINAC radiosurgery for cavernous sinus meningiomas.  Stereotact Funct Neurosurg. 1998;  71(1) 43-50
    CrossrefPubMedSearch in Google Scholar
  • 34 Dufour H, Muracciole X, Métellus P, Régis J, Chinot O, Grisoli F. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?.  Neurosurgery. 2001;  48(2) 285-294 discussion 294-296
    CrossrefPubMedSearch in Google Scholar
  • 35 Iwai Y, Yamanaka K, Nakajima H. Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas.  Surg Neurol. 2001;  56(5) 308-314
    CrossrefPubMedSearch in Google Scholar
  • 36 Roche P H, Pellet W, Fuentes S, Thomassin J M, Régis J. Gamma knife radiosurgical management of petroclival meningiomas results and indications.  Acta Neurochir (Wien). 2003;  145(10) 883-888, discussion 888
    CrossrefPubMedSearch in Google Scholar
  • 37 Subach B R, Lunsford L D, Kondziolka D, Maitz A H, Flickinger J C. Management of petroclival meningiomas by stereotactic radiosurgery.  Neurosurgery. 1998;  42(3) 437-443 discussion 443-445
    CrossrefPubMedSearch in Google Scholar

Ketan R BulsaraM.D. 

Department of Neurosurgery, Yale University School of Medicine

TMP4, 333 Cedar Street, New Haven, CT 06510

Email: ketan.bulsara@yale.edu