Petroclival meningiomas: is radical resection always the best option?

Abstract

Background-The surgical management of petroclival meningiomas is, despite the invaluable technical achievements in the past decade, still burdened by a high operative morbidity. It seems doubtful whether radical surgical removal should always be the primary goal in those lesions as advocated until very recently. Methods-A series was critically analysed and the literature discussed to elucidate criteria for a different attitude. Between 1990 and 1995 a total of 19 patients harbouring petroclival meningiomas were operated on. The following approaches were used: petrosal (n = 13), retrosigmoidal (n = 5), and subtemporal (n = 1). Thirteen lesions were removed completely and six incompletely as assessed by postoperative MRI. Results-No recurrence or regrowth could be detected on MRI after a mean follow up of 18 months. Surgical mortality occurred in one patient (5%) and there was early postoperative dysfunction in 56%. At the time of follow up major permanent operative morbidity was present in two patients (11%). Conclusions-In accord with recent literature subtotal resection of petroclival meningiomas should be contemplated in a subset of patients (with invasion of brain stem or cavernous sinus) to reduce the incidence of disabling deficits. Surgery should not be delayed in younger patients because surgical morbidity relates positively with tumour size.

The Simpson grading revisited: aggressive surgery and its place in modern meningioma management

“…On the other hand, we have also been keenly aware of the limitations of aggressive meningioma surgery. 20 For the present paper, we have analyzed our experience with this policy in a series of 901 patients. Our results show that the degree of resection (as measured by the Simpson grade) is a powerful predictor of tumor recurrence even in a contemporary patient series and therefore still conveys useful clinical information.…”

True petroclival meningiomas: results of surgical management

“…With the advent of radiosurgery, many have recommended subtotal removal and subsequent radiosurgery to avoid operative morbidity 1,7,21,28,33,34,42 One of the arguments for this approach is that subtotal removal decreases the likelihood of cranial nerve dysfunction and thus improves quality of life, and that pairing this approach with postoperative radiation may form the basis of safer tumor control. Cranial nerve dysfunction may still occur with a more cautious surgical approach and is often temporary after total or partial removal.…”

90Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas

“…A subgroup exhibits a diffuse en plaque growth pattern, and attachment of tumor segments to critical neural or vascular structures obviates complete resection. Attempts to resect meningiomas involving these critical structures may cause devastating vascular injury or disabling cranial neuropathies (2,3). Tumor remnants are treated radiotherapeutically, which leads to 5-y progression-free survival rates in 89% of benign and 48% of malignant cases (4).…”