Total Removal of Clivus Meningiomas and the Operative Results

Results of treatment of clivus meningiomas have been quite disappointing, primarily because of the position of the mass which is anterior to the brain stem and in direct contact with the vertebral and/or basilar artery. Most neurosurgeons consider it to be inoperable and simply perform a biopsy or partial removal. However, when the tumor is not too large and hard, total removal of a clivus meningioma should be tried with some precautions. The approach must be chosen to provide the shortest access to the main feeders, and multisided exposure should be obtained according to the location and the extension of the tumor. Out of our six cases of total removal, excellent results were obtained in two cases. In one of these two cases, an upper clivus meningioma was resected through a transpetrosal-transtentorial approach combined with a suboccipital approach, and in the other patient a middle clivus meningioma was removed through a suboccipital approach combined with extensive retrolabyrinthine removal of the petrosal bone. The operative results of the remaining cases were not so encouraging.