| OBJECTIVE: To review and analyze the therapeutic outcomes of microsurgical treatment of petroclival meningiomas(PCMs), and investigate the choice of surgical approach and the relative factors to the extent of tumor resection and patient’s prognosis, and explore the optimal surgical strategy of petroclival meningioma to improve surgical outcomes and postoperative quality of patient’s life.METHODS: A retrospective analysis of medical records, imaging studies, surgical information and follow-up date of 24 patients with PCMs who were received microsurgical treatment in Renji Hospital between January 2010 and December 2014 was reviewed. There were 10 males and 14 females(ratio, 1:1.4) with a mean age of(49.1±8.9) years(range 31-62 years). Patients complained of various initial symptoms including drinking cough, headache, unsteady gait, facial paresthesia, hearing impairment, decreased muscle strength, limb paresthesia, facial pain, blurred vision and diplopia with a mean duration of(16.3±29.6) months(range 0.1-120 months). The mean tumor diameter was(3.9±1.0) cm(range 2.3-5.5 cm). Surgical approaches were utilized including suboccipital retrosigmoid approach, presigmoid approach, subtemporal transtentorial approach, orbitozygomatic approach and far lateral approach.RESULTS: In 24 patients, gross total resection(Simpson Grade II) was achieved in 10 patients(41.7%), near total resection(Simpson Grade III) in 6 patients(25%), and partial resection(Simpson Grade IV) in 8 patients(33.3%). Postoperative morbidity included intracranial infection in 1 patient(4.2%), respiratory tract infection in 1 patient(4.2%), seizures in 1 patient(4.2%) and transient aphasia in 1 patient(4.2%). New-onset postoperative neurological deficits included oculomotor paralysis in 4 patients(16.7%), facial paralysis in 3 patients(12.5%), abducent paralysis in 2 patients(8.3%), hemiplegia in 2 patients(8.3%) and trigeminal nerve deficits in 1 patient(4.2%). There was no death during preoperative period. All 24 patients were followed up with a mean period of(31.4±17.5) months(range 1-62 month), and excellent quality of life in 18 patients(75%), good quality of life in 4 patients(8.3%), poor quality of life in 2 patients(8.3%). 5 of 8 PR received radiotherapy and there was no tumor progression/recurrence.The difference between follow-up KPS score and preoperative KPS score(t=-2.174, P=0.040) or postoperative KPS score(t=-3.301, P=0.003) was statistically significant. The rate of GTR was significantly associated with tumor consistency(P=0.022), cavernous sinus invasion(P=0.024) and brainstem adhesion(P=0.005). The follow-up KPS score was significantly affected by tumor consistency(P=0.001).CONCLUSION:1. Petroclival meningiomas were mostly benign, slow-growing, difficult surgery and high postoperative morbidity. If tumor’s diameter was less than 3cm and asymptomatic, patients could be followed up with serial imaging, and if tumor’s diameter was more than 3cm or became symptomatic, patients should be received surgical treatment;.2. Selected appropriate surgical approach according to tumor characteristics would improve the rate of GTR, suboccipital retrosigmoid approach was a simple, safe and effective surgical approach for petroclival meningiomas;3. The extent of resection was significantly associated with tumor consistency, cavernous sinus invasion and brainstem adhesion;4. The postoperative quality of life was significantly associated with tumor consistency;5. Adjuvant radiotherapy could control the growth of petroclival meningiomas effectively, and reduce tumor progression/recurrence;6. Adequate preoperative evaluation was very important. The tumor characteristics, patient’s condition, neurosurgeon’s experience and surgical goal should be considered to select the optimal surgical approach, individual treatment and find the balance between preserving maximal neurological function and increasing the extent of resection, GTR should be pursued to reduce postoperative morbidity and improve the quality of patient’s life. |
PDF Full Text Request