Keyhole approach surgery for petroclival meningioma

Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results The maximum diameter of tumors ranged from 2 to 7 cm （mean, 4.5 cm）. Gross total resection （GTR） was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection （STR） was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits （Ⅶ, Ⅶ, Ⅲ and lower CN）. One patient died in the postoperative period. Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.

Retrosigmoid-transtentorial approach for petroclival meningiomas: operative technique and clinical outcome

Background:Petroclival meningiomas (PCMs) are technically challenging lesions.Although the standard retrosigmoid approach is one of the most effective approaches,this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa.We provide a modified surgical technique called retrosigmoid-transtentorial approach (RTTA) to solve these problems.The feasibility and efficacy of the RTTA were studied,by analyzing neurological outcomes and considerations of surgical strategies.Methods:We analyzed 64 of 71 PCM patients (90.1％).All 64 patients had epicenter of tumor in the posterior fossa with varying degrees of extension into the supratentorial area and/or the middle fossa.A conventional retrosigmoid craniotomy was performed following which the tentorium was incised from the attachment of tumor toward the free edge,which improved exposure to the petroclival region by offering additional operative room without resection of the adjacent part of the petrous bone.Results:The rate of gross total resection was 71.9 ％.There was no incidence of intraoperative death.One patient died in the postoperative phase.The postoperative permanent morbidity rate was 25.4 ％.Follow-up was done with the mean time of 60.7 ± 47.5 months.There were 6 recurrence,8 progression and 7 death cases and the mean KPS score was 83.2 ± 13.4 in the last follow up.Conclusions:The RTTA achieves the goal of applying a safe,quick,uncomplicated,and lesser invasive access to the petroclival region which is indicated for tumors located in the posterior fossa with some extension into the supratentorial area and/or the middle fossa.