Summary
Background. Petroclival meningiomas are vaguely defined as tumours arising from the antero-medial zone to the internal auditory meatus. This report subclassifies petroclival meningiomas based on their origin determined by using radiological and intra-operative findings.
Method. Ninety-one patients with petroclival meningioma underwent surgery via the anterior transpetrosal approach. The Meckel’s cave was routinely opened. Tumour origin was classified into four subtypes according to the main attachment and trigeminal nerve deviation into, upper clivus (UC), cavernous sinus (CS), tentorium (TE), and petrous apex (PA). Their characteristic clinical symptoms and anatomical features were investigated.
Findings. The characteristic symptom was ataxia in the UC type (37.5%), abducens nerve palsy in the CS type (64.3%) and trigeminal neuropathy, mainly neuralgia in the PA type (80.0%) with a higher statistical difference from other subtypes. The rate of tumour invasion into Meckel’s cave reached 70.3% in average, with the lowest rate in the PA type (25.0%). The rate of middle fossa extension was the highest in the TE type (59.5%). The middle fossa approach was considered to be ideal for UC and TE types because of easier access to the Meckel’s cave. Radical dissection without complications was difficult in the CS type. Both the anterior transpetrosal approach and the lateral suboccipital approach could be indicated in the PA type due to the rare invasion of Meckel’s cave and middle fossa, and frequent extension into the internal auditory meatus.
Conclusions. This classification is useful to predict the relation between the tumour and the cranial nerves based on symptoms and images. The anterior transpetrosal approach could be used for all four subtypes and with an absolute indication in the UC and TE types showing middle fossa extension.
Similar content being viewed by others
References
KM Abdel Aziz A Sanan HR van Loveren JM Tew SuffixJr JT Keller ML Pensak (2000) ArticleTitlePetroclival meningiomas: predictive parameters for transpetrosal approaches Neurosurgery 47 139–150 Occurrence Handle10917357 Occurrence Handle10.1097/00006123-200007000-00030 Occurrence Handle1:STN:280:DC%2BD3M%2FnsV2nsg%3D%3D
O Al-Mefty JL Fox RR Smith (1988) ArticleTitlePetrosal approach for petroclival meningiomas Neurosurgery 22 510–517 Occurrence Handle3362317 Occurrence Handle1:STN:280:DyaL1c3gt1egtw%3D%3D Occurrence Handle10.1227/00006123-198803000-00010
O Al-Mefty RR Smith (1991) Clival and petroclival meningiomas Al-Mefty (Eds) Meningiomas Raven Press New York 41–42
AP Bricolo S Turazzi A Talacchi L Cristofori (1992) ArticleTitleMicrosurgical removal of petroclival meningiomas: a report of 33 patients Neurosurgery 31 813–828 Occurrence Handle1436406 Occurrence Handle10.1097/00006123-199211000-00001 Occurrence Handle1:STN:280:DyaK3s%2FmtlOguw%3D%3D
WT Couldwell P Kan JK Liu RI Apfelbaum (2006) ArticleTitleDecompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note J Neurosurg 105 148–152 Occurrence Handle16871891 Occurrence Handle10.3171/jns.2006.105.1.148
WT Couldwell JM Rosenow RL Rovit DL Benzil (2002) ArticleTitleHypophysopexy technique for radiosurgical treatment of cavernous sinus pituitary adenoma Pituitary 5 169–173 Occurrence Handle12812308 Occurrence Handle10.1023/A:1023313232296
T Kawase R Shiobara T Ohira S Toya (1996) ArticleTitleDevelopmental patterns and characteristic symptoms of petroclival meningiomas Neurol Med Chir (Tokyo) 36 1–6 Occurrence Handle10.2176/nmc.36.1 Occurrence Handle1:STN:280:DyaK283nsVWrtA%3D%3D
T Kawase R Shiobara S Toya (1994) ArticleTitleMiddle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality Acta Neurochir (Wien) 129 113–120 Occurrence Handle10.1007/BF01406489 Occurrence Handle1:STN:280:DyaK2M7kvFOqsw%3D%3D
T Kawase R Shiobara S Toya (1991) ArticleTitleAnterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients Neurosurgery 28 869–875 Occurrence Handle2067611 Occurrence Handle10.1097/00006123-199106000-00014 Occurrence Handle1:STN:280:DyaK3M3ps1Srtg%3D%3D
JW Markham CA Fager G Horrax JL Poppen (1955) ArticleTitleMeningiomas of the posterior fossa; their diagnosis, clinical features, and surgical treatment AMA Arch Neurol Psychiatry 74 163–170 Occurrence Handle14397893 Occurrence Handle1:STN:280:DyaG2M%2FpvFyhug%3D%3D
MR Mayberg L Symon (1986) ArticleTitleMeningiomas of the clivus and apical petrous bone. Report of 35 cases J Neurosurg 65 160–167 Occurrence Handle3723172 Occurrence Handle1:STN:280:DyaL283ltlentQ%3D%3D
M Samii M Tatagiba GA Carvalho (2000) ArticleTitleRetrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome J Neurosurg 92 235–241 Occurrence Handle10659009 Occurrence Handle1:STN:280:DC%2BD3c7it1Wiuw%3D%3D Occurrence Handle10.3171/jns.2000.92.2.0235
M Samii M Tatagiba GA Carvalho (1999) ArticleTitleResection of large petroclival meningiomas by the simple retrosigmoid route J Clin Neurosci 6 27–30 Occurrence Handle10833567 Occurrence Handle10.1016/S0967-5868(99)90598-2
M Samii KE Turel G Penkert (1985) ArticleTitleManagement of seventh and eighth nerve involvement by cerebellopontine angle tumours Clin Neurosurg 32 242–272 Occurrence Handle3933876 Occurrence Handle1:STN:280:DyaL28%2FlsVejsw%3D%3D
LN Sekhar DC Wright R Richardson W Monacci (1996) ArticleTitlePetroclival and foramen magnum meningiomas: surgical approaches and pitfalls J Neurooncol 29 249–259 Occurrence Handle8858531 Occurrence Handle10.1007/BF00165655 Occurrence Handle1:STN:280:DyaK2s%2FhtFGhsw%3D%3D
LN Sekhar S Pomeranz CN Sen (1991) ArticleTitleManagement of tumours involving the cavernous sinus Acta Neurochir Suppl (Wien) 53 101–112 Occurrence Handle1:STN:280:DyaK383gs1ajug%3D%3D
BR Subach LD Lunsford D Kondziolka AH Maitz JC Flickinger (1998) ArticleTitleManagement of petroclival meningiomas by stereotactic radiosurgery Neurosurgery 42 437–443 Occurrence Handle9526975 Occurrence Handle10.1097/00006123-199803000-00001 Occurrence Handle1:STN:280:DyaK1c7os1Wksw%3D%3D
F Umansky J Elidan A Valarezo (1991) ArticleTitleDorello’s canal: a microanatomical study J Neurosurg 75 294–298 Occurrence Handle2072168 Occurrence Handle1:STN:280:DyaK3Mzgtlagsw%3D%3D
T Van Havenbergh G Carvalho M Tatagiba C Plets M Samii (2003) ArticleTitleNatural history of petroclival meningiomas Neurosurgery 52 55–62 Occurrence Handle12493101 Occurrence Handle10.1097/00006123-200301000-00006
MG Yasargil RW Mortara M Cruic (1980) ArticleTitleMeningiomas of basal posterior cranial fossa Adv Tech Stand Neurusurg 7 1–115
Author information
Authors and Affiliations
Corresponding author
Additional information
Correspondence: Takeshi Kawase, M.D., Ph.D., Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjukuku, Tokyo 160-8582, Japan.
Rights and permissions
About this article
Cite this article
Ichimura, S., Kawase, T., Onozuka, S. et al. Four subtypes of petroclival meningiomas: differences in symptoms and operative findings using the anterior transpetrosal approach. Acta Neurochir (Wien) 150, 637–645 (2008). https://doi.org/10.1007/s00701-008-1586-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-008-1586-x