Conventional posterior fossa approach for surgery on petroclival meningiomas: A report on an experience with 28 cases

BACKGROUND This is a report of our experience with 28 cases of select petroclival meningiomas operated by a posterior fossa route encompassing the lateral supracerebellar-infratentorial and retrosigmoid avenues. METHODS Twenty-eight cases of petroclival meningiomas treated during the period 1991 to 2002 by conventional posterior cranial fossa route are analyzed. The average length of follow-up is 48 months. RESULTS The maximum diameter of the tumors ranged from 1.8 to 6.8 cm (mean, 4.0 cm). Five tumors extended up to or beyond the contralateral petroclival junction. Basilar artery was at least partially encased in 9 cases. Gross total tumor resection was achieved in 21 cases and a partial tumor resection was achieved in the remaining 7 cases. Two patients died in the postoperative phase. CONCLUSIONS Conventional posterior cranial fossa surgery can be suitable for a select group of petroclival meningioma. Apart from other advantages, it provides easy and quick exposure of the tumor without any petrous bone drilling. It also provides a direct and early exposure of the tumor-cranial nerve-brainstem interface facilitating the dissection. The lateral and inferior tumor extensions in relationship to the clivus, can be more easily accessed. The site of attachment of the tumor to the dura overlying the posterior face of the petrous apex can be seen directly. (C) 2004 Elsevier Inc. All rights reserved.