Is Retrosigmoid Approach Adequate for Resection of Petroclival Meningiomas?

Background: Petroclival meningiomas (PCMs) remain one of the most challenging intracranial tumors to treat surgically due to their deep location in the skull base and critical relation to vital neurovascular structures. Different skull base approaches are described in the literature for resection of these tumors. The retrosigmoid (RS) approach remains a standard approach to cerebellopontine angle (CPA) lesions including petroclival meningiomas.

Objective: The purpose of this study is to find out whether the retrosigmoid approach is adequate for excision of petroclival meningiomas.

Results: Out of 300 meningiomas operated on at KKUH during the period from 1990–2010, there were 100 skull base meningiomas, 17 of them were PCM. There were 10 women and 7 men, whose ages ranged from 20–69 years (mean, 44 years). The mean duration of symptoms was 22 months, and the common presenting features were headache in 70%, cranial nerve palsy in 53%, ataxia in 47%, raised ICP in 0.6%, motor weakness in 17.6%, and reduced sensation in the face in 17.6%. Tumor size was large (3–5 cm) in 11 patients (64.7%), greater than 5 cm in 4 patients (23.5%), and small (<3 cm) in 2 patients (11.7%). Total resection was achieved in 10 patients (59%). Postoperative complications included bulbar palsy in 5 patients (29.4%), facial nerve palsy in 4 patients (23.5%), hemiparesis in 2 patients (17.6%), and CSF collection in the wound in 2 patients (11.7%). The follow-up period ranged from 2–15 years (mean, 72 months). The outcome was good in 10 patients (58.8%), fair in 3 patients (17.6%), and poor in 2 patients; 2 patients died (11.8%). Tumor recurred in 23.5% at 4, 5, 6, and 8 years; all of them had STR, and 1 of the patients had multiple meningioma.

Conclusion: Total resection of petroclival meningioma is feasible through the retrosigmoid approach, and its morbidity is comparable to other extensive and lengthy skull base approaches.