Is the Retrosigmoid Approach Adequate for Resection of Petroclival Meningiomas?

Objective: To find out the whether retrosigmoid approach is adequate for excision of petroclival meningiomas.

Results: Out of 300 meningiomas operated on at KKUH during the period 1990–2010, there were 100 skull base meningiomas; 17 of them were PCM. There were 10 women and 7 men whose ages ranged from 20 to 69 years (mean, 44 years). The mean duration of symptoms was 22 months, and the common presenting features were headache in 70%, cranial nerve palsy in 53%, ataxia in 47%, raised ICP in 0.6%, motor weakness in 17.6%, and reduced sensation in the face in 17.6%. Tumor size was large (3–5 cm) in 11 patients (64.7%), >5 cm in 4 patients (23.5%), and small (<3 cm) in 2 patients (11.7%). Total resection was achieved in 10 patients (59%). Postoperative complications included bulbar palsy in five patients (29.4%), facial nerve palsy in four patients (23.5%), hemiparesis in two patients (17.6%), and CSF collection in the wound in two patients (11.7%). The follow-up period ranged from 2–15 years (mean, 72 months)—outcome was good in 10 patients (58.8%), fair in 3 patients (17.6%), poor in 2 patients, and 2 patients died (11.8%). Tumor recurred in 23.5% after (4, 5, 6, and 8 years); all of these had STR, and one of the patients had multiple meningiomas.

Conclusion: Total resection of petroclival meningiomas is feasible through the retrosigmoid approach, and its morbidity is comparable to other extensive and lengthy skull base approaches.