Surgery for Petroclival Meningiomas: A Comprehensive Review of Outcomes in the Skull Base Surgery Era

Skull base surgery has evolved to a point that its focus is now shifting to outcome analysis. To do so for petroclival meningiomas is difficult. The rarity of the tumor, different treatment philosophies, and variations in reporting complicate the outcome analysis. With this limitation in mind, we analyzed the literature on this disease and report the combined outcomes in a unified fashion in hopes that it will serve as a starting point for further prospective analysis. Data was extracted from all available reports on MEDLINE/PubMed published in English. All studies were retrospective and uncontrolled. The majority of studies represent the experience of a single surgeon at a single institution. Of the 19 studies with detailed demographic and outcome data, no data met criteria for meta-analysis. A total of 1000 patients were reported. The mean age of the patients was 50 years. The male to female ratio is 1:3. GTR (gross total resection) was reported in 49% of patients. Thirty-four percent of patients experienced some neurological deficit in the early postoperative period (<3 months). The most common morbidities reported were cranial nerve deficits (34.4% [range: 20 to 79%]) with facial nerve injury accounting for 19%, followed by motor deficits (14%), infection rates (1.6%), CSF leaks (5%), hemorrhage (1.2%), and hydrocephalus (1%). Death within 1 year of surgery was reported for 1.4% of patients. Once considered untreatable, petroclival meningiomas can now be approached relatively safely. There, however, still remains an similar to 34% morbidity with the most common being cranial nerve. Despite this, >75% of patients return to independence at 1 year, many of which will resume employment. The nature of this study limits the conclusions that can be drawn; however, it provides some generalizations that may help guide patient questions regarding treatment outcomes.