Ministry Of Petroclival Meningiomas Surgical Strategies

OBJECTIVE:To evaluate the possible risk factors for the unfavorable clinical outcomes of the surgical treatment to petroclival meningiomas and to explore the optimal surgical strategies concerning about the balance between postoperative status and tumor progression or recurrence rates.METHODS:We recruited 57 patients with petroclival meningioma who received operations in our hospital between the year of 2002 and 2006.There were 14 male and 43 female patients with a mean age of 50.5 years.Three patients had undergone a previous operation and one patient had two previous resections.The primary outcomes including postoperative neurological deficits,mRS score and recurrence rate was evaluated and the possible risk factors associated with the outcome were examined.The mean follow-up time was 34 months(range,10-67 months).RESULTS:Gross total resection(GTR) was achieved in 58%of patients,and near total resection(NTR) was achieved in 21%(12) of patients.Only one patient died in the peroperative period because of intracranial hemorrhage and one patient died by accident.67%patients experienced new postoperative cranial nerve deficits(32) or paresis(6) and 26%patients had a higher mRS score when assessed at the follow-up time.Postoperative complications were observed in 24 patients(42%).Postoperative radiation or radiosurgery was administered to 19 of the 24 patients who had residual tumors and no progression was found.Radiographic recurrence occurred in 12.3%of patients at a mean follow-up of 42 months.Tumor adhesion,hypervascularity and engulfment of neurovascular structures were three risk factors to increased modified Rankin scale score(p=0.0002;p=0.0051) and furthermore adhesion to adjacent structures obviously affected the extent of resection(p=0.0029).The risk of postoperative cranial nerve deficit increased with tumor engulfment of neurovascular structures(P=0.0004) and fibrous tumor consistency showed a tendency(P=0.0622). CONCLUSION:Intraoperatively defined tumor characteristics,especially tumor adherence played a critical role in identifying the subset of patients with an increased risk of postoperative morbidity and an unfavorable postoperative mRS score.Despite of a conservative attitude in the operation,an individualized strategy of treatment based on the careful preoperative evaluation could help to improve the quality of life.