Prognosis Of Petroclival Meningiomas After Microsurgical Resection And Their Prognostic Factors: A Consecutive Series Of 71 Cases Report.

Object:To study further neurological functional outcome, quality of life and tumor recurrence or progression of petroclival meningiomas after microsurgical resection. Analyze possible prognostic factors that may affect the extent of tumor resection and further quality of life.Material and Method:Retrospectively analyzed clinical and follow-up date in a consecutive series of 71 patients who underwent microsurgical treatment for petroclival meningiomas at Neurosurgery Department of XiangYa Hospital between 1991 and 2010 by the same surgeon (Professor Yuan Xianrui). All of the tumors were originated at petroclival region confirmed by intraoperative inspection. The main presenting symptoms were headache, paralysis, dysfunction of cranial nerve and balance, the mean duration of symptoms was 32±30 months. The mean tumor size was 44.4±11.25mm. The main approach used in this study was retrosigmoid.Detailed records of all follow-up patients were written down in a registration form, including the recovery of neurological function, quality of life, MRI. Univariately analyze possible prognostic factors that may affect the extent of tumor removal and recurrence of tumor by statistics soft, including CS invading, tumor size, tumor type, brain stem compression, sex, age, preoperative status. Results:Total resection(all were Simpson gradeⅡ) reached in 67.6%(48/71 cases).1(1.4%) died postoperative. There were 64 cases had follow-up, and mean follow-up period was 60.7±47.5 months. During the follow-up,7 patients died, including 4 died of tumor progression and 3 died of unrelated diseases. The mean quality of life score (KPS) was 83.2,66.7% patients regained full daily activity (KPS Score 80-100) and 31.6%patients were able to live at home and care for most personal needs (KPS Score 60-70) and the rate of disability is 25.4%. Clinical and MR imaging data revealed tumor recurrence after total resection in 6 cases and the rate is 13.3%(6 out of 45 cases), and the rate of tumor progression after subtotal resection 42.2%(8 out of 19 cases).Univariate analysis showed that the tumor removal was favorably affected by no CS involvement, small tumor,type of turner, soft of tumor constitute; and further life quality was favorable affected by high score of preoperative KPS, no CS involvement, soft of tumor constitute, type of tumor and the extent of tumor removal.(P<0.05).Conclusion:1. Microsurgery via retrosigmoid approach is safe and reliable treatment for petroclival meningiomas, can get a good long-term function outcome.2. The extent of tumor removal was affected by no CS involvement, small tumor, type of turner,soft of tumor constitute. 3. The rate of postoperative complications of petroclival meningio-mas were relative high, and the prognosis was not optimistic. Further life quality was favorable affected by high score of preoperative KPS, no CS involvement, brain stem compression, soft of tumor constitute, type of tumer,and the extent of tumor removal, however, of not related to tumor size.