Surgical Management of Posterior Fossa Meningiomas: Operative Techniques, Complications and Outcome in 59 Cases

Background: Resection of posterior fossa meningiomas carries a high rate of surgical complications compared with resection of supratentorial meningiomas. We present our experience in the management of patients with these tumors and focus on the surgical technique for the different locations and on the rate and management of complications

Methods: WE conducted a retrospective case-series review of 59 consecutive patients undergoing resection of posterior fossa meningiomas between 2003 and 2013. The medical records of these patients as well as pre and postoperative imaging studies were reviewed.

Results: Forty-eight female and 10 male patients, with a mean age of 55 (range 17–81) were treated. Tumor location was in the cerebellopontine angle (CPA) in 24 (41%), 12 (20%) posterior petrous, 9 (15%) foramen magnum, 9 (15%) petroclival (PC) and 5 (8%) tentorial meningiomas. Surgical approach was retrosigmoid in 48 casesmidline suboccipital in 9, and presigmoid posterior petrosectomy approach in 2. Complete surgical resection was achieved in most of the CPA, foramen magnum and posterior petrous meningiomas and in none of the PC. Complications included mainly temporary cranial nerve injuries. There was 1 death one month after surgery. In 1 case there was clinical deterioration with posterior fossa high pressure that required craniectomy for decompression and EVD.

Conclusion: Surgery for posterior fossa meningiomas presents significant risks that must be expected and addressed. Total resection should be attempted in most cases, although it is not the goal of surgery in certain locations, especially in petroclival meningiomas. Complications include temporary cranial nerve deficit and postoperative increased pressure in the posterior fossa with secondary hydrocephalus.