Management of Meningiomas of the Posterior Petrous Face: The Gruppo Otologico Experience

Objective: The objective of the present study was to report our surgical strategy in the management of posterior petrous face meningiomas. Study Design: Retrospective study. Material and Methods: All patients of posterior fossa meningiomas underwent surgical excision based on the protocol followed at our center. The approaches include translabyrinthine approach, enlarged translabyrinthine approach with transapical extension, modified transcochlear approaches, combined retrosigmoid-retrolabyrinthine approach, transpetrous and enlarged middle cranial fossa approach, and combination approaches including translabyrinthine transapical orbitozygomatic approach and extreme lateral approach. Results: Total removal of the tumor was achieved in most patients (>90%). The facial nerve was anatomically preserved in 97.5% patients. The patients with preoperative serviceable hearing who underwent hearing preservation surgery, 74% had hearing preserved. Around 4% had new onset cranial nerve deficit. Conclusion: Total tumor removal (Simpson grade I-II) remains our treatment of choice and takes priority over hearing preservation. Subtotal resection is indicated for older and debilitated patients with giant lesions to relieve tumor compression. Subtotal removal is also preferred in the absence of a plane of cleavage between the tumor and the brainstem, encasement of vital neurovascular structures and elderly patients with tumors adherent to preoperatively normal facial or lower cranial nerves.