Surgical treatment in petroclival meningioma:clinical analysis of 49 cases

Objective To study the principle of selecting surgical approach, prevention and treatment of complication in petroclival meningioma for further improving the surgical effects. Methods The clinical data of 49 patients with petroclival meningioma hospitalized during January 1995-April 2003 were analyzed retrospectively. The clinical manifestations of these cases were cranial nerve impairment, headache, weakness of extremities and ataxia, 45 cases of them with tumor diameter 4.5 cm. According to their locations on clivus revealed on MRI, tumors were divided into three categories ie: upper 2/3 of the clivus (typeⅠ), whole clivus (typeⅡ) and lower 2/3 clivus (typeⅢ). Of the 23 cases with typeⅠtumors, 12 were operated via subtemporal cerebellar-tentorial approach, 8 via Kawase approach and 3 via subtemporal presigmoid sinus approach; while in 19 cases of typeⅡtumors, subtemporal presigmoid sinus approach was performed in 8, subtemporal labyrinthine approach in 2 and suboccipital retromastoid approach in 9; all the 7 cases with type Ⅲ tumors were operated via suboccipital extremelateral approach. Results In total of the 49 patients, tumors in 35 cases (71.4%)were totally removed, 10 subtotally (more than 2/3 of mass volume) resected and 4 partially (less than 1/3 mass volume) resected. Postoperative complications included: coma and hemiplegia (n=2), quadriplegia (n=1), and one died from pneumonia resulted in cranial nerve plegia. Cranial nerve impairment or worsened symptoms occurred in 18 cases and most of patients' function recovered postoperatively within 3 months. Conclusion The principle of selecting surgical approach should be based on the location of tumor in clivus and the possibility of total resection of tumor.