Abstract
Background
The surgical resection of petroclival meningiomas (PCMs) remains a challenge. Both the relationship with neurovascular structures and the deep location of the tumor can affect the extent of resection and the rate of post-operative morbidity.
Methods
The authors performed a systematic review and meta-analysis of the literature examining the rate of new cranial nerve (CN) deficits after resection of PCM. A systematic search of two databases was performed for studies published between 1990 and 2018. Random-effect meta-analysis was used to pool the rate of post-operative CN deficits, mortality rate, and rate of radical resection.
Results
We included twelve studies and 334 patients harboring PCM. The overall rate of complete resection was 68% (95% CI 57.9–78.2%; p < 0.01; I2 = 83%). The rate of early and late post-operative CN deficits was the following: 3.8 and 2.7% (III CN), 6.6 and 3% (IV), 7.3 and 5.5% (V CN), 8 and 3.6% (VI CN), 8.9 and 8.9%% (VIII), and 4 and 2.7% (IX-XI CNs) (I2 = 0%, and p < 0.01 for all analyses). The risk of post-operative deficit of the IV CN was higher among the petrosal group (7.6%; I2 = 0% vs 2.1%; I2 = 0%), whereas the impairment of VII CN function was higher among retrosigmoid group (16.6%; I2 = 64.6% vs 11.4%; I2 = 52.8%), but it was transient in the majority of cases.
Conclusions
This systematic review and meta-analysis provides a detailed overview of post-operative CN deficits ensuing surgical resection of PCMs. These findings should be acknowledged when counseling patients with PCMs regarding the more appropriate approach for their tumor.
References
Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O (2014) True petroclival meningiomas: results of surgical management. J Neurosurg 120:40–51. https://doi.org/10.3171/2013.8.JNS13535
Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22:510–517. https://doi.org/10.1227/00006123-198803000-00010
Arnaout O, Al-Mefty O (2017) Combined petrosal approach for petroclival meningioma. Neurosurg Focus 43:V6. https://doi.org/10.3171/2017.10.FocusVid.17343
Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, Spetzler RF (2007) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 61:202–211. https://doi.org/10.1227/01.neu.0000303218.61230.39
Borghei-Razavi H, Shibao S, Schick U (2016) Petroclival meningioma: patient’s outcomes can be improved by being flexible when choosing the surgical approach. World Neurosurg 87:481–482
Bricolo AP, Turazzi S, Talacchi A, Cristofori L (1992) Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31:813–828; discussion 828. https://doi.org/10.1227/00006123-199211000-00001
Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28. https://doi.org/10.3171/jns.1996.84.1.0020
DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials. https://doi.org/10.1016/j.cct.2015.09.002
Elarjani T, Shetty R, Singh H, da Silva HB, Sekhar LN (2017) Transpetrosal approach to petro-clival meningioma. Neurosurg Focus 43:V1. https://doi.org/10.3171/2017.10.FocusVid.17214
Erkmen K, Pravdenkova S, Al-Mefty O (2005) Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus 19:E7. https://doi.org/10.3171/foc.2005.19.2.8
Hanakita S, Watanabe K, Champagne P-O, Froelich S (2019) How I do it: combined petrosectomy. Acta Neurochir (Wien) 1–5. https://doi.org/10.1007/s00701-019-04022-z
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327:557–560. https://doi.org/10.1136/bmj.327.7414.557
Hirohata M, Abe T, Morimitsu H, Fujimura N, Shigemori M, Norbash AM (2003) Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas. Neuroradiology 45:656–660. https://doi.org/10.1007/s00234-003-1056-3
Horgan MA, Anderson GJ, Kellogg JX, Schwartz MS, Spektor S, McMenomey SO, Delashaw JB (2000) Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg 93:108–112. https://doi.org/10.3171/jns.2000.93.1.0108
Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:866–869
Kawase T, Shiobara R, Toya S (1994) Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir (Wien) 129:113–120
Kawase T, Shiobara R, Ohira T, Toya S (1996) Developmental patterns and characteristic symptoms of petroclival meningiomas. Neurol Med Chir (Tokyo) 36:1–6
Kawase T, Yoshida K, Uchida K, Ohira T (2001) Anterior transpetrosal approach for petroclival tumors. Skull Base 11:19. https://doi.org/10.1016/S0531-5131(02)01055-5
Klinger DR, Flores BC, Lewis JJ, Barnett SL (2013) The treatment of cavernous sinus meningiomas: evolution of a modern approach. Neurosurg Focus. https://doi.org/10.3171/2013.9.FOCUS13345
Kusumi M, Fukushima T, Mehta AI, Aliabadi H, Nonaka Y, Friedman AH, Fujii K (2012) Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas. J Neurosurg 116:566–573. https://doi.org/10.3171/2011.11.JNS11985
Mathiesen T, Gerlich A, Kihlstrom L, Svensson M, Bagger-Sjoback D (2007) Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 60:982. https://doi.org/10.1227/01.NEU.0000255476.06247.F1
Mathiesen T, Gerlich A, Kihlstrom L, Svensson M, Bagger-Sjoback D (2007) Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 60:982. https://doi.org/10.1227/01.neu.0000333787.06221.e5
Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (reprinted from annals of internal medicine). Phys Ther 89:873–880. https://doi.org/10.1371/journal.pmed.1000097
Samii, Tatagiba, Carvalho (1999) Resection of large petroclival meningiomas by the simple retrosigmoid route. J Clin Neurosci Off J Neurosurg Soc Australas 6:27–30. https://doi.org/10.1054/jocn.1997.0201
Samii M, Tatagiba M (1992) Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir 118:27–32. https://doi.org/10.1007/bf01400723
Samii M, Tatagiba M, Carvalho GA (2000) Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome. J Neurosurg 92:235–241. https://doi.org/10.3171/jns.2000.92.2.0235
Sassun TE, Ruggeri AG, Delfini R (2016) True petroclival meningiomas: proposal of classification and role of the combined supra-infratentorial presigmoid retrolabyrinthine approach. World Neurosurg 96:111–123. https://doi.org/10.1016/j.wneu.2016.08.023
Sekhar LN, Schessel DA, Bucur SD, Raso JL, Wright DC (1999) Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area. Neurosurgery 44:532–537. https://doi.org/10.1097/00006123-199903000-00060
Sen C, Hague K (1997) Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection. J Neurosurg. https://doi.org/10.3171/jns.1997.87.4.0535
Shibao S, Borghei-Razavi H, Orii M, Yoshida K (2015) Anterior transpetrosal approach combined with partial posterior petrosectomy for petroclival meningiomas with posterior extension. World Neurosurg 84:574–579. https://doi.org/10.1016/j.wneu.2015.03.055
Tatagiba M, Samii M, Matthies C, Vorkapic P (1996) Management of petroclival meningiomas: a critical analysis of surgical treatment. Acta Neurochir Suppl 65:92–94. https://doi.org/10.1007/978-3-7091-9450-8_25
Tatagiba M, Rigante L, Mesquita Filho P, Ebner FH, Roser F (2015) Endoscopic-assisted posterior intradural petrous apicectomy in petroclival meningiomas: a clinical series and assessment of perioperative morbidity. World Neurosurg 84:1708–1718. https://doi.org/10.1016/j.wneu.2015.07.033
Watanabe T, Katayama Y, Fukushima T, Kawamata T (2011) Lateral supracerebellar transtentorial approach for petroclival meningiomas: operative technique and outcome. J Neurosurg 115:49–54. https://doi.org/10.3171/2011.2.JNS101759
Yamakami I, Higuchi Y, Horiguchi K, Saeki N (2011) Treatment policy for petroclival meningioma based on tumor size: aiming radical removal in small tumors for obtaining cure without morbidity. Neurosurg Rev 34:325–327. https://doi.org/10.1007/s10143-011-0308-7
Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J (1997) Petroclival meningiomas: is radical resection always the best option? J Neurol Neurosurg Psychiatry 62:341–345. https://doi.org/10.1136/jnnp.62.4.341
Acknowledgments
We thank Prof. Beth De Felici for the English revision.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflicts of interest.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Ethical approval
For this type of study, formal consent is not required.
Informed consent
The nature of this article did not require informed consent.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Tumor - Meningioma
Rights and permissions
About this article
Cite this article
Di Carlo, D.T., Capo, G., Fava, A. et al. Petroclival meningiomas: the risk of post-operative cranial nerve deficits among different surgical approaches—a systematic review and meta-analysis. Acta Neurochir 162, 2135–2143 (2020). https://doi.org/10.1007/s00701-020-04395-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-020-04395-6