Postoperative Complications and Neurological Deficits after Petroclival and Sphenopetroclival Meningioma Resection

Introduction: Surgical management of meningiomas involving the petroclival junction is challenging due to proximity to critical neurovascular structures.

Objective: The objective was to describe surgical outcomes and identify factors associated with postoperative complications and new neurologic deficits in patients undergoing resection of petroclival or sphenopetroclival meningiomas.

Methods: A retrospective review of patients after petroclival or sphenopetroclival meningioma resection from 1993 to 2020 was performed. Logistic regression was performed to identify variables associated with postoperative complications and new neurological deficits.

Results: A total of 64 patients underwent a total 53 one-stage and 11 two-stage resections. Median age was 49 years, 71.8% of patients were female, and median follow-up was 18.6 months. Preoperatively, 59.4% of patients had cranial nerve (CN) III–VIII deficits, and 14.1% had extremity weakness. Median tumor volume was 22.3 cm³. Tumors were WHO grade I (90.6%) and II (9.4%), 35.1% had FLAIR in the brainstem, 61.4% had peritumoral cerebrospinal fluid cleft, 62.3% involved cavernous sinus, 75.0% involved Meckel's cave, 12.5% had bone hyperostosis, 38.3% had hydrocephalus, and 12.5% had intratumoral calcification. Posterior petrosectomy was performed in 78.1% of operations and anterior petrosectomy in 7.8%. Most resections were subtotal or near-total (93.7%). Rates of surgical and medical complications were 37.5 and 7.8%. Postoperatively, 66.7% of patients had new CN deficits and 51.9% retained deficits at last follow-up. New extremity weakness was observed in 17.5% at discharge and 11.1% at last follow-up. Posterior petrosectomy was significantly associated with complications (p = 0.0450, OR = 8.67, 95% CI: 1.54–163.63). Posterior petrosectomy and two-stage resection were associated with new neurological deficits persisting at last follow-up on multivariate analysis (p = 0.0107, OR = 17.53, 95% CI: 2.8–349.43, and p = 0.0273, OR = 21.27, 95% CI: 2.33–744.41).

Conclusions: Posterior petrosectomy is associated with risk of postoperative complications, and along with two-stage resection, is associated with persistent neurological deficits. These data are useful in operative planning and risk communication with patients.