J Neurol Surg B Skull Base 2016; 77 - FP-14-02
DOI: 10.1055/s-0036-1592507

The Transpetrous Approaches System in the Management of Posterior Fossa Meningiomas

Roberto Pareschi 1, Giovanni Danesi 2, Catalina Iglesias 2
  • 1ENT and Skull Base Microsurgery Department, Legnano, Italy
  • 2ENT and Skull Base Microsurgery Department and Neurosciences Department,, Bergamo, Italy

Objective: Posterior fossa meningiomas are located in the cerebellopontine angle (CPA) and petroclival region, arising respectively from pre/perimeatal dura (CPAM) or from petroclival dura (PCM).

The aim of this study is to evaluate the rate of complete removal of posterior fossa meningiomas and the rate of the related complications.

Methods: The charts of 80 patients with posterior fossa meningioma treated in two regional tertiary skull base centers were reviewed. 45 occurred on the perimeatal dura, 6 on the premeatal, and 29 on the petroclival one. A transtentorial extension was identified in 13 patients, and in 2 patients the tumor had an extension to the jugular foramen. In the CPAM group, 17 patients underwent a translabyrinthine approach, 15 translabyrinthine-transapical, 6 petro-occipital-transigmoid, 2 retrolabyrinthine-subtemporal-transapical, and 11 retrosygmoid approach.

In the PCM group a pure modified transcochlear approach was used in 16 patients, a combined translabyrinthine-transapical-transtentorial approach in 4 patients, a transcochlear-transtentorial in 3 patients, and a presigmoid-retrolabyrinthine-transtentorial in 6 patients.

Results: A total removal was achieved in 90% of cases (71/80). Three recurrences were identified in the cavernous sinus and parasellar region, 4 in the jugular foramen and 2 in the petroclival region.

The overall surgical mortality was 0%. Postoperative additional neurological deficits were observed to be strictly related to tumor location. When the meningiomas were totally removed we didn't observe any recurrences.

Conclusion: Transpetrous approaches represent a safe and reliable system to manage posterior fossa meningiomas with a very high rate of complete removal and acceptable morbidity rate.