Petroclival meningiomas: study on outcomes, complications and recurrence rates

Clinical article

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Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates.


Fifty patients underwent surgical treatment for petroclival meningiomas. The majority of the patients were women (72%). The authors retrospectively reviewed the patients' medical records, imaging studies, and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, and recurrence rates.


Headache was the most common presentation (58%). The most commonly used approach was the transpetrous approach (in 16 patients), followed by the orbitozygomatic approach (in 13). Gross-total resection was performed in 14 patients (28%), and in the remaining patients there was residual tumor (72%). Eighteen patients with tumor remnants were treated with Gamma Knife surgery. New postoperative cranial neuropathies were noted in 22 patients (44%). The most common cranial nerve (CN) deficit following surgery was CN III dysfunction (in 11 patients) and facial weakness (in 10). In 9 patients, the CN dysfunction was transient (41%), and 7 patients had permanent dysfunction (32%). Eight patients developed hydrocephalus and all required placement of a ventriculoperitoneal shunt. A CSF leak was noted in only 2 patients (4%), and wound dehiscence was noted in 1. The CSF leaks and the wound dehiscence occurred in patients who were undergoing reoperations. Adequate radiographic follow-up (minimum 6 months) was available for 31 patients (62%). The mean follow-up was 22.1 months. In 6 patients, tumor progression or recurrences were noted. The median time to recurrence was 84 months. At the time of discharge from the hospital, 92% of the patients had good outcomes (Glasgow Outcome Scale Scores 4 and 5). Three patients died of causes not directly related to the surgery.


Petroclival meningiomas still pose a formidable challenge to neurosurgeons. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome (Glasgow Otcome Scale Score 4 or 5) in 92% of patients, although the extent of gross-total resection was only 28%. The authors' primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. The authors favor the treatment of residual tumor or recurrent tumor with stereotactic radiosurgery.

Abbreviations used in this paper: CN = cranial nerve; CPA = cerebellopontine angle; GOS = Glasgow Outcome Scale; GTR = gross-total resection; GSPN = greater superficial petrosal nerve; SRS = stereotactic radiosurgery; STR = subtotal resection; VP = ventriculoperitoneal.

Article Information

Address correspondence to: Anil Nanda, M.D., Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, Louisiana 71130-33932. email:

Please include this information when citing this paper: published online December 24, 2010; DOI: 10.3171/2010.11.JNS10326.

© AANS, except where prohibited by US copyright law.



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    Pie chart showing the numerous surgical approaches used to resect the petroclival meningiomas. The most commonly used approaches were the transpetrosal and orbitozygomatic approaches. The numbers before the commas indicate the number of patients.

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    The majority of the residual tumors in our series underwent either Gamma Knife surgery (GKS) or follow-up.

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    The GOS score was used to evaluate neurological outcome following excision. The numbers before the commas indicate the number of patients.

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    Kaplan-Meier survival analysis showing the overall recurrence-free survival plot. Only 31 patients with follow-up longer than 6 months were included.

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    A and B: Preoperative CT scans showing gross calcification of the tumor. C–F: Preoperative MR images showing a large petroclival meningioma with obstructive hydrocephalus in a 70-year-old patient with hypertension, diabetes, and dyslipidemia. The patient underwent VP shunt placement only, and the tumor is undergoing follow-up. Over the past 3 years, the tumor has remained stable. Conservative management is a good option for asymptomatic tumors, especially in elderly patients and in those with risk factors for surgery.

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    Preoperative CT scan (A) and MR images (C and D) showing a large petroclival meningioma causing brainstem compression. B: Computed tomography angiogram showing a large enhancing mass consistent with a meningioma. E and F: Postoperative MR images showing a small remnant.

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    Left: Preoperative MR image showing a large petroclival meningioma with sphenocavernous extension. Right: Postoperative CT scan showing a small residual tumor.

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    Axial T2-weighted (A) and T1-weighted (B) MR images obtained after contrast administration, showing a large right-sided petroclival meningioma. There was a small residual tumor that was treated with radiosurgery. Images showing the Gamma Knife surgery plan for the tumor remnant (C).


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