Management of Petroclival Tumors

Objective: Management of petroclival tumors is challenging. Tumors in the petroclival region may have different origins resulting in distinct positions and displacement of normal neurovascular structures. The objective of this project is to do a thorough preoperative analysis to decide which surgical approach is appropriately tailored to each case.

Methods: A series of 20 petroclival tumors was analyzed. Each case was prospectively reviewed to decide the surgical approach. Postoperatively, each case was reanalyzed evaluating several preoperative factors including tumor type, tumor origin, consistency, and nerve and arterial involvement.

Results: The series included nine petroclival meningiomas, one clival meningioma, three trigeminal schwannomas, three epidermoid, two petrous apex meningiomas, two glomus jugulare tumor, and two tentorial meningioma. In each case, the preoperative factors were analyzed and the surgical approach was decided based on it. The selected approaches were anterior petrosal (eight cases), posterior petrosal (five), combined anterior and posterior petrosal (two), and retrosigmoid (two). The postoperative deficit was analyzed.

Conclusion: Each case should be preoperatively analyzed to tailor the approach to each case. The skull base surgeon is required to have a full armamentarium of surgical approaches according to the need of each case. The origin and the displacement of the cranial nerves are the most important preoperative risk factors to consider when deciding the surgical approach to avoid postoperative cranial nerve deficit.