Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution.

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors' institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1-368 months) and 105 months (range 1-348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors' preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

[1]  Jacob B. Hunter,et al.  Tumor Progression Following Petroclival Meningioma Subtotal Resection: A Volumetric Study. , 2018, Operative neurosurgery.

[2]  S. Paek,et al.  Gamma Knife Radiosurgery for Petroclival Meningioma: Long-Term Outcome and Failure Pattern , 2017, Stereotactic and Functional Neurosurgery.

[3]  Jie Tang,et al.  Surgical management of medium and large petroclival meningiomas: a single institution’s experience of 199 cases with long-term follow-up , 2016, Acta Neurochirurgica.

[4]  I. Bhagavatula,et al.  Surgical management of petroclival meningiomas: Factors affecting early post-operative outcome , 2015, British journal of neurosurgery.

[5]  M. Sughrue,et al.  Management of Petroclival Meningiomas: A Review of the Development of Current Therapy , 2014, Journal of Neurological Surgery—Part B.

[6]  I. Dunn,et al.  True petroclival meningiomas: results of surgical management. , 2014, Journal of neurosurgery.

[7]  C. Megerian,et al.  Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. , 2013, Neurosurgical focus.

[8]  Jie Tang,et al.  Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients , 2013, Acta Neurochirurgica.

[9]  James H. Nguyen,et al.  Gamma knife surgery for skull base meningiomas. , 2012, Journal of neurosurgery.

[10]  Xin-Guang Yu,et al.  The retrosigmoid approach to petroclival meningioma surgery , 2011, Journal of Clinical Neuroscience.

[11]  A. Nanda,et al.  Petroclival meningiomas: study on outcomes, complications and recurrence rates. , 2011, Journal of neurosurgery.

[12]  Madjid Samii,et al.  Petroclival meningiomas: quo vadis? , 2011, World neurosurgery.

[13]  Y. Higuchi,et al.  Treatment policy for petroclival meningioma based on tumor size: aiming radical removal in small tumors for obtaining cure without morbidity , 2011, Neurosurgical Review.

[14]  A. Samii,et al.  Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension , 2011, Neurosurgical Review.

[15]  D. Kondziolka,et al.  Long-term control of petroclival meningiomas through radiosurgery. , 2010, Journal of neurosurgery.

[16]  V. Seifert.  Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life , 2010, Acta Neurochirurgica.

[17]  K. Bulsara,et al.  Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era. , 2008, Skull base : official journal of North American Skull Base Society ... [et al.].

[18]  A. Tahara,et al.  Petroclival meningiomas: Surgical management and common complications , 2009, Journal of Clinical Neuroscience.

[19]  R. Spetzler,et al.  Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. , 2007, Neurosurgery.

[20]  A. Morita,et al.  PETROCLIVAL MENINGIOMAS: MULTIMODALITY TREATMENT AND OUTCOMES AT LONG‐TERM FOLLOW‐UP , 2007 .

[21]  S. Paek,et al.  The selection of the optimal therapeutic strategy for petroclival meningiomas. , 2006, Surgical neurology.

[22]  K. Erkmen,et al.  Surgical management of petroclival meningiomas: factors determining the choice of approach. , 2005, Neurosurgical focus.

[23]  A. Friedman,et al.  Surgical Management of Petroclival Meningiomas: Defining Resection Goals Based on Risk of Neurological Morbidity and Tumor Recurrence Rates in 137 Patients , 2005, Neurosurgery.

[24]  L. Sekhar,et al.  Petroclival and foramen magnum meningiomas: Surgical approaches and pitfalls , 1996, Journal of Neuro-Oncology.

[25]  M. Samii,et al.  Natural History of Petroclival Meningiomas , 2003, Neurosurgery.

[26]  O. Al-Mefty.  Operative atlas of meningiomas , 1998 .