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Management of petroclival meningiomas
Date Issued |
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2012-10-03 |
Objective: To compare results of surgical removal of petroclival meningiomas depending on their size. Background: Petroclival meningiomas present one of the biggest challenges in skull base surgery because of the high potential morbidity of radical surgical extirpation and their low potential for incapacitating symptomatology. Petroclival meningiomas are more challenging because of their frequent tight relationship with the brainstem and the cranial nerves. Because of their slow growth, cerebral compensation takes place and they can reach large sizes. Materials and Methods: This is a retrospective study report of our experience with petroclival meningioma patients operated on between 1991 and 2010 in the Department of Neurosurgery of Lithuanian University of Health Sciences. In total, 81 patients with petroclival meningiomas were treated in our department: in 29 cases the tumor was smaller than 3 cm in diameter, in 52 cases it was larger. The follow-up period was 60 ± 48 months. Radical removal (Simpson II) of the tumor was achieved in 96.5% of small meningiomas and in 90% of large meningiomas. In all cases of small meningiomas, the retrosigmoid approach was used. Conclusion: In cases of small petroclival meningiomas, the retrosigmoid approach is sufficient for radical removal of the tumor without new neurological deficits. For large petroclival meningiomas, the approach should be tailored to the tumor's size, location, and extension, combined with modern microsurgical cranial base techniques, which allow removal of petroclival meningiomas with minimal permanent morbidity, excellent neurological outcome, and very low recurrence rates.