Skip to main content
SpringerLink
Log in

Posterior petrous bone meningiomas: surgical experience in 53 patients and literature review

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Meningiomas of the posterior fossa represent a heterogeneous group of tumors regarding difficulty of resection and functional outcome. The aim of this review was to focus on tumors located mainly on the posterior surface of the petrous bone and threatening hearing and facial functions. An anatomical classification was used to evaluate surgical outcome depending on the relationship of the tumor to the internal auditory meatus. The authors performed a retrospective chart review of 53 consecutive patients operated on for a posterior petrous bone meningioma in a tertiary referral center and a literature review. Tumors were classified in four groups according to the modified Desgeorges and Sterkers classification: posterior petrous (P; 17 tumors), meatus and internal auditory canal (M; 12 tumors), petrous apex without invasion of the internal auditory canal (A; 9 tumors), and cerebellopontine angle with invasion of the internal auditory canal (AMP; 15 tumors). The facial function was preserved in 100% of P and A tumors, 75% of group M tumors, and 53% of AMP tumors. Hearing preservation was attempted only in P, A, and M groups where rates of serviceable hearing preservation were 82%, 80%, and 66%, respectively. The cumulative rate of hearing preservation for AMP tumors was 45% in our literature review. The increased facial morbidity associated with AMP tumors compared with other groups was also confirmed by the review of the literature. In conclusion, this study shows that among posterior petrous bone meningiomas, tumors invading the internal auditory canal present with increased postoperative functional morbidity in spite of a tailored approach regarding dural insertion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Ausman JI (2006) A revolution in skull base surgery: the quality of life matters! Surg Neurol 65(6):635–636

    Article  PubMed  Google Scholar 

  2. Bacciu A, Piazza P, Di Lella F, Sanna M (2007) Intracanalicular meningioma: clinical features, radiologic findings, and surgical management. Otol Neurotol 28(3):391–399

    Article  PubMed  Google Scholar 

  3. Bassiouni H, Hunold A, Asgari S, Stolke D (2004) Meningiomas of the posterior petrous bone: functional outcome after microsurgery. J Neurosurg 100(6):1014–1024

    Article  PubMed  Google Scholar 

  4. Batra PS, Dutra JC, Wiet RJ (2002) Auditory and facial nerve function following surgery for cerebellopontine angle meningiomas. Arch Otolaryngol Head Neck Surg 128(4):369–374

    PubMed  Google Scholar 

  5. Breuer T, Gjuric M, Wigand ME (2000) Extended middle fossa surgery for meningiomas within or at the internal auditory canal. Am J Otol 21(5):729–734

    PubMed  CAS  Google Scholar 

  6. Bricolo AP, Turazzi S, Talacchi A, Cristofori L (1992) Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31(5):813–828, discussion 828

    Article  PubMed  CAS  Google Scholar 

  7. Castellano F, Ruggiero G (1953) Meningiomas of the posterior fossa. Acta Radiol 104:3–157

    Google Scholar 

  8. Anonymous (1995) Committee on hearing and equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 113:179–180

    Google Scholar 

  9. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84(1):20–28

    Article  PubMed  CAS  Google Scholar 

  10. Darrouzet V, Guerin J, Aouad N, Dutkiewicz J, Blayney AW, Bebear JP (1997) The widened retrolabyrinthe approach: a new concept in acoustic neuroma surgery. J Neurosurg 86(5):812–821

    Article  PubMed  CAS  Google Scholar 

  11. Desgeorges M, Sterkers O (1994) Anatomo-radiological classification of meningioma of the posterior skull base. Neurochirurgie 40(5):273–295

    PubMed  CAS  Google Scholar 

  12. Desgeorges M, Sterkers O, Poncet JL, Rey A, Sterkers JM (1995) Surgery for meningioma of the posterior skull base. 135 cases. Choice of approach and results. Neurochirurgie 41(4):265–290, discussion 290–264

    PubMed  CAS  Google Scholar 

  13. Devèze A, Franco-Vidal V, Liguoro D, Guerin J, Darrouzet V (2007) Transpetrosal approaches for meningiomas of the posterior aspect of the petrous bone Results in 43 consecutive patients. Clin Neurol Neurosurg 109(7):578–588

    Article  PubMed  Google Scholar 

  14. House JW (1983) Facial nerve grading systems. Laryngoscope 93(8):1056–1069

    Article  PubMed  CAS  Google Scholar 

  15. Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K (2010) The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 113(5):1072–1078

    Article  PubMed  Google Scholar 

  16. Kano T, Kawase T, Horiguchi T, Yoshida K (2010) Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence. Acta Neurochir (Wien) 152(1):79–86, discussion 86

    Article  Google Scholar 

  17. Kawase T, Shiobara R, Ohira T, Toya S (1996) Developmental patterns and characteristic symptoms of petroclival meningiomas. Neurol Med Chir Tokyo 36(1):1–6

    Article  PubMed  CAS  Google Scholar 

  18. Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28(6):869–875, discussion 875–866

    Article  PubMed  CAS  Google Scholar 

  19. Lang DA, Neil-Dwyer G, Garfield J (1999) Outcome after complex neurosurgery: the caregiver’s burden is forgotten. J Neurosurg 91(3):359–363

    Article  PubMed  CAS  Google Scholar 

  20. Lecuire J, Dechaume JP, Buffard P, Bochu M (1971) Meningiomas of the posterior cranial fossa. Neurochirurgie 17:1–146

    PubMed  CAS  Google Scholar 

  21. Liu JK, Gottfried ON, Couldwell WT (2003) Surgical management of posterior petrous meningiomas. Neurosurg Focus 14(6):e7

    Article  Google Scholar 

  22. Nakamura M, Roser F, Dormiani M, Matthies C, Vorkapic P, Samii M (2005) Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas. Neurosurgery 57(1):77–90, discussion 77–90

    Article  PubMed  Google Scholar 

  23. Nakamura M, Roser F, Mirzai S, Matthies C, Vorkapic P, Samii M (2004) Meningiomas of the internal auditory canal. Neurosurgery 55(1):119–127, discussion 127–118

    Article  PubMed  Google Scholar 

  24. Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 60(6):965–979, discussion 979–981

    Article  PubMed  Google Scholar 

  25. Qu FJ, Zhou XD, Wang XL, Li F, Lu XD, Liu YG, Zhong YH, Yang HA, Ni SL (2009) The classification of posterior petrous meningiomas and its clinical significance. J Int Med Res 37(3):949–957

    PubMed  CAS  Google Scholar 

  26. Raj Wijetunga LH, Fagan PA, Sheehy JP (1998) Petrous apex meningiomas: an alternative surgical approach. J Clin Neurosci 5(3):310–317

    Article  PubMed  CAS  Google Scholar 

  27. Roberti F, Sekhar LN, Kalavakonda C, Wright DC (2001) Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 56(1):8–20, discussion 20–21

    Article  PubMed  CAS  Google Scholar 

  28. Rosenorn J (1989) The risk of ischaemic brain damage during the use of self-retaining brain retractors. Acta Neurol Scand Suppl 120:1–30

    Article  PubMed  CAS  Google Scholar 

  29. Rosenorn J, Diemer NH (1982) Reduction of regional cerebral blood flow during brain retraction pressure in the rat. J Neurosurg 56(6):826–829

    Article  PubMed  CAS  Google Scholar 

  30. Roser F, Nakamura M, Dormiani M, Matthies C, Vorkapic P, Samii M (2005) Meningiomas of the cerebellopontine angle with extension into the internal auditory canal. J Neurosurg 102(1):17–23

    Article  PubMed  Google Scholar 

  31. Samii M, Tatagiba M (1992) Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir Wien 118(1–2):27–32

    Article  PubMed  CAS  Google Scholar 

  32. Sanna M, Bacciu A, Pasanisi E, Taibah A, Piazza P (2007) Posterior petrous face meningiomas: an algorithm for surgical management. Otol Neurotol 28(7):942–950

    Article  PubMed  Google Scholar 

  33. Schaller B, Merlo A, Gratzl O, Probst R (1999) Premeatal and retromeatal cerebellopontine angle meningioma. Two distinct clinical entities. Acta Neurochir Wien 141(5):465–471

    Article  PubMed  CAS  Google Scholar 

  34. Seifert V (2010) Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20years. Acta Neurochir (Wien) 152(7):1099–1116

    Article  Google Scholar 

  35. Sekhar LN, Jannetta PJ (1984) Cerebellopontine angle meningiomas. Microsurgical excision and follow-up results. J Neurosurg 60(3):500–505

    Article  PubMed  CAS  Google Scholar 

  36. Sekhar LN, Jannetta PJ, Burkhart LE, Janosky JE (1990) Meningiomas involving the clivus: a six-year experience with 41 patients. Neurosurgery 27(5):764–781, discussion 781

    Article  PubMed  CAS  Google Scholar 

  37. Selesnick SH, Nguyen TD, Gutin PH, Lavyne MH (2001) Posterior petrous face meningiomas. Otolaryngol Head Neck Surg 124(4):408–413

    Article  PubMed  CAS  Google Scholar 

  38. Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, Parsa AT (2010) The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg 113(5):1029–1035

    Article  PubMed  Google Scholar 

  39. von Eckardstein KL, Driscoll CLW, Link MJ (2010) Outcome after microsurgery for meningiomas involving the internal auditory canal. Neurosurgery 67(5):1236–1242

    Article  Google Scholar 

  40. Voss NF, Vrionis FD, Heilman CB, Robertson JH (2000) Meningiomas of the cerebellopontine angle. Surg Neurol 53(5):439–446, discussion 446–437

    Article  PubMed  CAS  Google Scholar 

  41. Wu ZB, Yu CJ, Guan SS (2005) Posterior petrous meningiomas: 82 cases. J Neurosurg 102(2):284–289

    Article  PubMed  Google Scholar 

  42. Yasargil M, Mortara R, Curcic M (1980) Meningiomas of basal posterior cranial fossa. Adv Tech Stand Neurosurg 7:3–115

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hopital Beaujon, 100 bvd du Général Leclerc, 92110, Clichy, France

    Matthieu Peyre, Alain Rey & Michel Kalamarides

  2. Department of Otology and ENT surgery, Hopital Beaujon, 100 bvd du Général Leclerc, 92110, Clichy, France

    Alexis Bozorg-Grayeli & Olivier Sterkers

  3. Université Paris Diderot, Paris 7, France

    Matthieu Peyre, Alexis Bozorg-Grayeli, Alain Rey, Olivier Sterkers & Michel Kalamarides

Authors
  1. Matthieu Peyre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexis Bozorg-Grayeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alain Rey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Sterkers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michel Kalamarides
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Kalamarides.

Additional information

Comments

Sunil Manjila, Nicholas C. Bambakidis, Cleveland, USA

We read with interest the clinical case series of 53 cases of posterior petrous meningiomas, with special attention to the facial nerve function and serviceable hearing loss; their surgical outcome is impressive at 35 months of mean follow-up. The established facts about these lesions are reassertained: more anterior lesions are less amenable to GTR, residual tumors are commonly left in the petrous apex/cave area, subtotal resections are reserved for debilitated patients and poor brainstem interface, and cumbersome hearing and facial nerve preservation with advanced tumors. It is noted that the authors have used transpetrous approaches in majority of the patients (57%) compared with the common workhorse approach—retrosigmoid suboccipital approach. We agree with the use of these approaches in selected circumstances, though we feel that acceptable Simpson grades of resection can be achieved using a standard retrosigmoid approach. We reserve use of combined transpetrosal approaches in cases in which tumors are located entirely medial to the internal acoustic meatus and span both the posterior and middle cranial fossae. In most of such cases, we attempt to preserve hearing unless it has been preoperatively compromised or if tumor size dictates that a greater degree of exposure is required.

Andreas Raabe, Bern, Switzerland

In this interesting paper, the authors classify the risk of surgery of posterior petrosal tumors according to their location in respect to the internal auditory canal. Their series is large and the classification makes sense, however, it is not surprising. In our institution, we do not always consider tumors of the posterior petrous bone to threaten the VII/VIII nerve but only those in contact with the internal auditory canal. This is confirmed by the functional results of this study with a 100% preservation rate for the facial nerve in the petrous apex and posterior petrous tumors. Tumors of the internal auditory canal and CPA-meningiomas with invasion of the internal auditory canal had less favorable facial nerve preservations of 75% and 53%. As expected, the results of hearing preservation are less favorable but show a similar risk distribution. Interestingly, the authors used predominantly transpetrous approaches, contrary to our practice of using retrosigmoid approach for most cases. This may be explained by the fact that we do not follow the rule of the authors to always attack a meningioma from the site of dural attachment. This is certainly the best approach in terms of interrupting the blood supply and complete tumor resection but not necessarily for a multimodal treatment concept focusing on preservation of the facial and hearing nerve. Subtotal resection can also be the surgical goal for tumors invading the internal auditory canal followed by radiosurgical treatment. I would just repeat one of the key statements of the article: “In an era of multimodal treatment, gross-total resection is not mandatory to achieve functional preservation and good tumor control.” The authors should be congratulated for their study, techniques, and outcomes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Peyre, M., Bozorg-Grayeli, A., Rey, A. et al. Posterior petrous bone meningiomas: surgical experience in 53 patients and literature review. Neurosurg Rev 35, 53–66 (2012). https://doi.org/10.1007/s10143-011-0333-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-011-0333-6

Keywords

Search

Navigation