Transpetrosal Approaches for Cerebellopontine Angle Meningiomas: Multidisciplinary Experience in 43 Cases

Purpose: To assess outcome following excision of cerebellopontine angle (CPA) meningiomas through transpetrosal approaches.

Method: A case series retrospective study in a multidisciplinary tertiary care center of all patients who underwent meningioma removal from January 1989 to September 2005. Surgical approaches were transpetrosal: widened retrolabyrinthine, translabyrinthine, transotic, and transcochlear occasionally combined with a subtemporal transtentorial approach. Epidemiology, symptoms, preoperative evaluation, surgery, postoperative complications, and facial and auditory results were analyzed using standardized grading systems. The Desgeorges and Sterkers classification was used to assess tumor size and location.

Results: Forty women and 3 men underwent surgery (mean age, 56.7 yrs). Medium-sized tumors stage 2 and 3 (84%) and AM and P localization (34% and 20.4%) predominated. In 65% of cases, the tumor extended beyond the CPA. Main presenting symptoms were balance disorders (72%) and sensorineural hearing loss (53.5%). Mortality was null. A preoperative facial nerve paresis was present in 14% of patients. Tumor removal was complete in 79.1% of cases. At 1 year postop, 73% of patients had a normal or subnormal facial function and 55% had serviceable hearing. A cerebrospinal fluid leakage occurred in 6.9%.

Conclusions: Posteriorly attached meningiomas are less symptomatic and of better prognosis than medially inserted ones. Transpetrosal approaches are reliable for the removal for all types and sizes of such tumors, and can be easily combined in the same procedure with a subtemporal transtentorial approach to remove extensions to the clivus and tentorium. They offer low morbidity and high proportion of facial nerve and hearing preservation.