True Petroclival Meningiomas: Proposal of Classification and Role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine Approach.

True Petroclival Meningiomas: Proposal of Classification and Role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine Approach.

World Neurosurg. 2016 Aug 24;

Authors: Sassun TE, Ruggeri AG, Delfini R

Abstract
BACKGROUND: The evolution of Petroclival Meningiomas (PMs) surgical treatment has lead nowadays to a tendency to abandon complex petrous approaches and return to "less aggressive" skull base approaches.
OBJECTIVE: To propose a PMs classification and establish the role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine (CSIPR) approach in the treatment of PMs rigorously matching the anatomical definition.
METHODS: A retrospective analysis was conducted of 51 cases of PMs strictly adhering to the anatomical definition, operated on from January 1990 to December 2011. On the basis of the different patterns of growth from a common anatomical region of origin, a classification of PMs in four groups is proposed.
RESULTS: Gross total resection was achieved in 32 patients (63%), subtotal resection (at least 90% tumor volume removal) in 14 patients (27%). Each of the four groups of the proposed classification lends itself to be removed by a distinct surgical approach. Statistical analysis confirmed that such group-approach pairings significantly correlate with radical surgical removal (P< .001). Despite the high incidence of early postoperative complications, at late follow-up 82% of patients were free of significant postoperative neurological deficits (95% Confidence Interval: 70-90). Comparable neurological improvement was observed limited to cases treated by CSIPR (P= .60).
CONCLUSIONS: For each PM group the most suitable approach was identified, in terms of surgical radicality and low postoperative morbidity. CSIPR can be considered the approach of choice for the most frequent group of PMs in our series. We believe that the CSIPR remains a valuable option for PMs treatment.

PMID: 27567583 [PubMed - as supplied by publisher]

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