The History of the Development of Management Strategies for Petroclival Meningiomas

Objective: The surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of these tumors. The developments of a multitude of surgical approaches as well as innovations in neuroimaging and stereotactic radiation have proved powerful options for multimodality management of these challenging tumors. Study Design, Material, and Methods: We review major series of petroclival meningioma patients, comparing classification, imaging techniques, operative technique, outcome, and use of adjuvant radiotherapy modalities. Results: A total of 69 publications were organized into their historical relevance, surgical approach, and treatment modality. Patient demographics and outcome data of major series are detailed. In our own management of these tumors, four major variables exist. We summarize treatment recommendations based on these variables in Fig. 1. Conclusion: Despite development of modern surgical technology and multimodality therapy, petroclival meningiomas continue to present a treatment challenge. The optimal treatment in symptomatic patients regardless of size remains GTR, if feasible. Management strategies for patients based on age, symptom burden, and cavernous sinus involvement are detailed. Meticulous radiologic follow-up is essential, and radiosurgery is effective for CS involvement or residual disease control.