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DOI: 10.1055/s-0032-1314235
Management of Petroclival Meningioma: Toward Better QOL
Introduction: Petroclival meningioma (PCM) is one of the most formidable tumors to manage in neurosurgery. A retrospective analysis of the author's approach to PCM was done to observe the trend in PCM management to achieve a better QOL.
Material and Method: There were 93 PCM patients out of 1120 cerebellopontine angle (CPA) tumors operated on by the author between 1988 and 2011. Sixty-five cases were treated by microsurgery, 15 by gamma knife radiosurgery (GKR), and 13 by combined microsurgery and GKR.
Results: In the first 10 years (1988–1997), there were 34 cases of PCM, all operated on microsurgically. During 1998–2011, there were 59 cases, of which 31 were managed microsurgically, 13 by combined microsurgery and GKR, and 15 by GKR alone. In the 1988–1997 timeframe, only 20% were operated on through a retrosigmoid craniotomy and the rest by a dedicated skull base approach (anterior or posterior petrosal). From 1998–2011, nearly 60% were operated on by the retrosigmoid approach. The postoperative morbidity was significantly lower in the latter half of the study, where the policy has been to leave tumors densely adherent to critical neurovascular structure and in the cavernous sinus. GKR is advised for such residue. One postoperative mortality occurred.
Conclusion: Recently, there has been a trend toward the retrosigmoid approach. Radiosurgery has been utilized and found useful either as an adjunct to microsurgery or the sole modality. This change in strategy has resulted in better QOL.