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Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients

  • Clinical Article - Brain Tumors
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Abstract

Background

Surgical management of petroclival meningiomas is challenging. Various and inconsistent outcome and prognostic factors of the lesions have been evaluated previously. In the present study, the surgical outcome, philosophy, and experience of petroclival meningiomas are detailed based on a large patient series.

Methods

A series of 259 patients with petroclival meningiomas (70 males and 189 females) were surgically treated. Clinical charts and radiographs were reviewed. Follow-up results were evaluated.

Results

The preoperative Karnofsky Performance Scale (KPS) score was 74.2 ± 10.5. The mean tumor size was 4.3 ± 1.0 cm. The gross total resection (GTR) rate was 52.5 %. During a mean follow-up period of 55.3 months, recurrence/progression (R/P) occurred in 11 patients. The recent KPS score was 78.4 ± 22.7, it improved in 139 (57.2 %) patients and stabilized in 53 (21.8 %) patients, and 201 (82.7 %) patients lived independently. The risk factors affecting the KPS score included (but were not limited to) age ≥ 60, preoperative KPS ≤ 60, and brainstem edema. The adverse factors contributing to R/P-free survival included (but were not limited to) non-total resection and the absence of the subarachnoid space. The R/P-free survival rate was 94.5 % at 5 years and 91.2 % at 9 years. The overall survival rate was 94.7 % at 5 years and 94.7 % at 9 years.

Conclusions

Favorable outcomes from petroclival meningiomas could be achieved by microsurgery. Neurological function and quality of life were prioritized, and GTR was attempted. Risk factors should be considered in surgical schemes, and tumor recurrence should be aggressively monitored and treated.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China

    Da Li, Shu-Yu Hao, Liang Wang, Jie Tang, Xin-Ru Xiao, Hui Zhou, Gui-Jun Jia, Zhen Wu, Li-Wei Zhang & Jun-Ting Zhang

  2. Tiantan Xili 6, Chongwen Distract, Beijing, 100050, People’s Republic of China

    Jun-Ting Zhang

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  1. Da Li
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  2. Shu-Yu Hao
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  3. Liang Wang
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Correspondence to Jun-Ting Zhang.

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Comment

This impressive series illustrates a nationally centered approach to a formidable surgical problem. It is important for surgeons to realise that we may make our patients worse (see Table 9) but these tumors may remain unchanged for a long time without intervention. The skill is to realize which patient to select for surgery and then by which method.

Michael Powell

London, UK

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Li, D., Hao, SY., Wang, L. et al. Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir 155, 1367–1383 (2013). https://doi.org/10.1007/s00701-013-1795-9

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  • DOI: https://doi.org/10.1007/s00701-013-1795-9

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