Results in Surgical Treatment of Clival and Petroclival Meningiomas

Introduction Clival and petroclival meningiomas present a major challenge for every neurosurgeon. Different approaches are used according to the experience of each qualified surgeon. The results are contradictive and depend on a multitude of factors.

Aim To analyze the results of surgical treatment in 12 patients with clival and petroclival meningiomas according to different surgical approaches, tumor location and size, extent of tumor resection, and patients' preoperative status.

Material and Methods For a period of 4 years, 12 patients underwent surgery for clival and petroclival meningiomas in the Clinic of Neurosurgery of the Military Medical Academy, Sofia. Different surgical approaches were used according to location—anterior transpetrosal approach when the location was at the superior third of clivus, retrosigmoid approach with or without suprameatal extension when the tumor was at middle third of the clivus, and far-lateral approach for a processes at the inferior third of clivus. In patients with large tumor size, we used a combined (subtemporal and retrosigmoid) approach.

Results Retrosigmoid approach was used in five cases (41.6%), anterior transpetrosal approach in three (25%), far-lateral approach in two (16.7%), and combined approach in two (16.7%). Gross total resection was achieved in eight (66.6%) patients. Postoperatively, three (25%) of the patients did not have any neurological deficit, two (16.7%) had transitory facial palsy and hearing decrease, five (41.6%) had permanent hearing loss, and two (16.7%) patients died.

Conclusion The use of specific approach according to localization and tumor size provides a chance of gross total removal and a decreases the complication and mortality rates.

Keywords clival and petroclival meningiomas; surgical approach; complications