Petroclival Meningiomas: Experience in Argentinian Center

Abstract

Introduction: Petroclival meningiomas are challenging tumors located in a critical region at the skull base. These tumors often present with specific clinical manifestations due to their proximity to vital structures such as cranial nerves (CN) and major blood vessels. Management often requires a multidisciplinary approach and due to its complexity and risks, some studies even propose stereotactic radiosurgery (SRS) as an alternative to surgery. This study aims to demonstrate our experience in the treatment of petroclival meningiomas.

Materials and Methods: Single-center, retrospective study of a cohort of 64 surgical patients operated for petroclival meningioma in a third-level center in Buenos Aires, Argentina, between 2010 and 2023. Medical records, imaging studies, and surgical protocols were reviewed. Patients with an age greater than 18 years old, a mean follow-up of at least 6 months and adequate pre- and postoperative contrast-enhanced volumetric MRI were included.

Results: A total of 53 patients met the inclusion criteria with a mean age of 52 years (range 25–78), a predilection for female sex (73.58%) and a mean follow-up of 54.6 months (range 6–182). Headaches, facial numbness, hypoacusis and gait impairment were the most frequent symptoms at consultation. Dysphagia and dysphonia were seen in 22.6%. Preoperative mean KPS was 86. Regarding tumor characteristics, mean tumor volume was 24.8 cm3 (range 1.8–67.3) with brainstem compression seen in 92.45% of cases. Calcifications were noticed in 16.98% of tumors. A complete cleft sign was identified in 24% and partial in 37.7% of cases, with signs of brainstem edema in 18.87%. Retrosigmoid approach was the main route chosen for tumor resection (56.6%) followed by presigmoid (35.85%) and frontotemporal approach (7.5%). A Gross-total-resection was achieved in 22.64% and Near-Total in 33.96%, with a Simpson I-III resection rate of 64.15%. Residual tumor was managed with postoperative gamma-knife in 52.8% of cases. Mean hospital-stay was 9.9 days. Most frequent complications seen were new postoperative CN deficit (75%) and meningitis (11.32%) of which 3.7% were infectious. CSF leak was seen in 3.7% of patients and more serious complications such as vasospasm, ischemia or hematomas were seen in 3.7% respectively with two patients needing surgery for management. There were no postoperative deaths. Mean early postoperative KPS and at last follow-up were 78.8 and 84.15 respectively with a mean GOS at last follow-up of 4.56. A total of 22.64% of patients needed discharge to a rehabilitation center, and improvement in CN deficits were totally seen in 28.3% and partial in 52.83% of cases.

Conclusion: Surgical resection of petroclival meningiomas is considered the mainstay of treatment. However, due to the complex anatomy and potential for neurological deficits, careful preoperative planning and precise intraoperative techniques are paramount for good outcomes. Leaving a residual tumor in favor of minimizing the risk of permanent postoperative morbidity is often needed, with the aid of postoperative advanced SRS techniques. Further research is needed to enhance patient care.