Summary
Fourty-two patients with petroclival meningioma were operated upon by the middle fossa transpetrosal-transtentorial approaches since 1977. Half of those showed tumour extension into the middle fossa and one-third in the cavernous sinus. Seventeen (40%) had a large tumour of 40 mm in diameter or larger, and 8 of those had a broad attachment from the clivus to petrous pyramid of the temporal bone. The site of pyramid resection was selected from three types, depending on the tumour location and the patients' pre-operative hearing. There was no surgical mortality. Significant risk of lower cranial nerves palsy was minimal and useful hearing was preserved in 18 out of 21 patients. The follow-up, an average of 4 and a half years, showed tumours were completely eradicated in 32 patients (76%) and there was regrowfh in 3 (7%). Thirty-four patients (81%) were independent, 3 disabled and only one died of rapid tumour regrowth. The most influential factor on surgical results was the extent to which the tumour had invaded the brain stem. The presence or absence of arterial encasement and of peritumoural oedema on MRI were important in the selection for radical surgery.
Similar content being viewed by others
References
Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22: 510–517
Fisch U (1983) The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope 93: 36–44
Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura T (1977) Clivus meningioma: six cases of total removal. Neural Med Chir (Tokyo) 17: 63–77
Hakuba A, Nishimura S, Jang BJ (1988) A combined retroauricular and preauricular transpetrosal transtentorial approach to clivus meningiomas. Surg Neurol 30: 108–116
Kanzaki J, Ogawa K, Shiobara R (1989) Hearing preservation in acoustic neuroma surgery and post-operative audiological findings. Acta Otolaryngol [Suppl] 107: 474–478
Kawase T, Toya S, Shiobara R, Kimura C, Nakajima H (1987) Skull base approaches for meningiomas invading the cavernous sinus. In: Dolenc W (ed) The cavernous sinus. Springer, Wien New York, pp 346–354
Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosaltranstentorial approach for sphenopetro-clival meningiomas: surgical method and results in 10 patients. Neurosurgery 2: 869–876
Morrison AW, King TT (1973) Experiences with a translabyrinthine-transtentorial approach to the cerebellopointine angle. Technical note J Neurosurg 38: 382–390
Samii M, Ammirati M (1988) The combined supra-infratentorial presigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir (Wien) 95: 6–12
Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A (1989) Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24: 12–17
Sekhar LN, Jannetta PJ, Burkhart LE, Janosky JE (1990) Meningiomas involving the clivus: a 6-year experience with 41 patients. Neurosurgery 27: 764–781
Sen CN, Sekhar LN (1990) The subtemporal and preauricular infratemporal approach to infradural structures ventral to the brain stem. J Neurosurg 73: 345–354
Shiobara R, Ohira T, Kanzaki J, Toya S (1989) A modified extended middle cranial fossa approach for acoustic nerve tumors. J Neurosurg 68: 358–365
Yarsargil MG, Mortara RW, Curic M (1980) Meningiomas of basal posterior cranial fossa. Adv Tech Stand Neurosurg 7: 1–115
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kawase, T., Shiobara, R. & Toya, S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas selective pyramid resection and radicality. Acta neurochir 129, 113–120 (1994). https://doi.org/10.1007/BF01406489
Issue Date:
DOI: https://doi.org/10.1007/BF01406489