Surgical Management of Petroclival Meningiomas: Results and choice of an approach
https://doi.org/10.59156/revista.v37i02.496
DOI:
https://doi.org/10.59156/revista.v37i02.496Keywords:
Meningiomas, Petroclival region, Retrosigmoid, Anterior Transpetrosal, Posterior TranspetrosalAbstract
Introduction: Meningiomas of the Petroclival Region (MRPC) are benign tumors that arise circumscribed in an anatomical region of difficult surgical access comprised, between the superior and middle clivus, and the posterior aspect of the petrous bone medial to the internal auditory canal. The surgical management of these tumors represents a challenge in modern neurosurgery. The object of the present work is describing the surgical results in a series of cases and to guide the reader in the selection of the appropriate surgical approach based on our experience.
Materials and Methods: We included 30 patients operated on with MRPC from June 2005 to September 2022.
Results: Of the 30 MRPC treated, the average age was 52.7 years, and the predominant sex was female in 83.3% of the cases. The most common implantation site was the petroclival fissure in 66% of cases. The most used surgical approach was the retrosigmoid in 44% of the cases followed by the presigmoid in 23%. A resection of 95% or more was achieved in 73% of the cases. Finally, we present nine relevant clinical cases.
Conclusions: The results of this series coincide with the perception of the literature on the management of this pathology. The choice of an approach is a determining factor in achieving a promising surgical outcome.
Downloads
References
Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O. True petroclival meningiomas: results of surgical management. J Neurosurg. 2014 Jan;120(1):40-51. doi: 10.3171/2013.8. JNS13535. Epub 2013 Oct 25. PMID: 24160473.
Kim JW, Jung HW, Kim YH, Park CK, Chung HT, Paek SH, Kim DG, Lee SH. Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution. J Neurosurg. 2019 May 10;132(6):1675-1682. doi: 10.3171/2019.2. JNS182604. PMID: 31075775.
Steiger HJ. Surgical management of medium and large petroclival meningiomas: benchmark and limits. Acta Neurochir (Wien). 2016 Mar;158(3):407-8. doi: 10.1007/s00701-015-2686-z. Epub 2016 Jan 4. PMID: 26729264.
Xu F, Karampelas I, Megerian CA, Selman WR, Bambakidis NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus. 2013 Dec;35(6):E11. doi: 10.3171/2013.9. FOCUS13319. PMID: 24289119.
Nishimura S, Hakuba A, Jang BJ, Inoue Y. Clivus and apicopetroclivus meningiomas--report of 24 cases. Neurol Med Chir (Tokyo). 1989 Nov;29(11):1004-11. doi:10.2176/nmc.29.1004. PMID: 2483855.
Labib MA, Zhao X, Houlihan LM, Abramov I, Inoue M, Martinez-Perez R, Catapano JS, Lawton MT, Preul MC, Youssef AS. A two-stage combined anterolateral and endoscopic endonasal approach to the petroclival region: an anatomical study and clinical application. Acta Neurochir (Wien). 2022 Jul;164(7):1899-1910. doi: 10.1007/s00701-022-05201-1. Epub 2022 Apr 13. PMID: 35416540.
Bambakidis NC, Kakarla UK,Kim LJ, Nakaji P, Porter RW, & Daspit CP, et al.: Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 61:5 Suppl 2 202–211, 2007.
Couldwell WT, , Fukushima T, , Giannotta SL, & Weiss MH: Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28, 1996.
Jung HW, , Yoo H, , Paek SH, & Choi KS: Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 46:567–575, 2000.
Little KM, Friedman AH, Sampson JH, 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 56:546–559, 2005.
Flannery TJ, Kano H, Lunsford LD, Sirin S, , Tormenti M, & Niranjan A, et al.: Long-term control of petroclival meningiomas through radiosurgery. Clinical article. J Neurosurg 112:957–964, 2010.
Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M. Natural history of petroclival meningiomas. Neurosurgery. 2003 Jan;52(1):55-62; discussion 62-4. doi: 10.1097/00006123-200301000-00006. PMID: 12493101.
Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery. 2000 Mar;46(3):567-74; discussion 574-5. doi: 10.1097/00006123-200003000-00008. PMID: 10719852.
Sekhar L, Schramm V. Tumors of the Cranial Base: Diagnosis and Treatment. Mt Kisco Futur Pub Co (1987).
Natarajan S, Sekhar L, Schessel D, Morita A. Petroclival Meningiomas: Multimodality Treatment and Outcomes at Long-Term Follow-Up. Neurosurgery (2007) 60:965–79. doi: 10.1227/01.NEU.0000255472. 52882.D6.
Morisako H, Goto T, Ohata K. Petroclival Meningiomas Resected via a Combined Transpetrosal Approach: Surgical Outcomes in 60 Cases and a New Scoring System for Clinical Evaluation. J Neurosurg (2015) 122:373–80. doi: 10.3171/2014.8.JNS132406.
King TT: Combined translabyrinthine-transtentorial approach to acoustic nerve tumours. Proc R Soc Med 63:780–782, 1970.
Guinto G, Hernández E, Estrada E, Gallardo D, Kageyama M, Aréchiga N, Guinto-Nishimura GY. Petroclival Meningiomas: A Simple System That Could Help in Selecting the Approach. Oper Neurosurg (Hagerstown). 2021 Sep 15;21(4):225-234. doi: 10.1093/ons/opab224. PMID: 34293125; PMCID: PMC8440063.
Kawase T,Toya S, , Shiobara R, & Mine T: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857–861, 1985.
Siwanuwatn R, , Deshmukh P, , Figueiredo EG, , Crawford NR, , SpetzlerRF, & Preul MC: Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region. J Neurosurg 104:137–142, 2006.
Chang WS, Wu A, Gore P, Beres E, Porter RW, & Preul MC, et al.: Quantitative comparison of Kawase's approach versus the retrosigmoid approach: implications for tumor involving both middle and posterior fossae. Neurosurgery 64:3 Suppl ons44–ons52, 2009.
House WF: Transtemporal bone microsurgical removal of acoustic neuromas. Evolution of transtemporal bone removal of acoustic tumors. Arch Otolaryngol 80:731–742, 1964.
House WF, & Hitselberger WE: The transcochlear approach to the skull base. Arch Otolaryngol 102:334–342, 1976.
King TT: Combined translabyrinthine-transtentorial approach to acoustic nerve tumours. Proc R Soc Med 63:780–782, 1970.
Morisako H, Goto T, Ohata K. Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation. J Neurosurg. 2015 Feb;122(2):373-80. doi: 10.3171/2014.8.JNS132406. Epub 2014 Nov 7. PMID: 25380114.
Sassun T, Ruggeri A, Delfini R. True petroclival meningiomas: proposal of classification and role of the combined supra-infratentorial presigmoid retrolabyrinthine approach. World Neurosurg 2016;96: 111–23.
Al-Mefty O, DeMonte F, McDermott M, Al-Mefty’s Meningiomas. 2nd ed. New York: Thieme; 2011:270–282.
Hrvoje Barić, Vladimir Trkulja, Vjerislav Peterković & Goran Mrak (2022) Mortality and morbidity in surgically treated patients with petroclival meningiomas: a systematic review and meta-analysis of case series, British Journal of Neurosurgery, 36:4, 501-10, DOI: 10.1080/02688697.2022.2033700
