Management Experience Of Petroclival Meningiomas And Preservation Of Quality Of Life About85Cases

Objectives:Analyze different aspects of petroclival meningiomas including location, histology, surgery approaches, complication and outcome altogether with possible prognostic factors that may affect the extent of tumor resection and further quality of life. Discuss the management strategies used in comparison with international experience.Material and Method:During the period approximately22years, between January1991and December2013,85patients with petroclival meningiomas were managed clinically and microsurgical by the same surgeon (Professor Yuan Xian rui) in Neurosurgical Department of XiangYa Hospital. In our study all patients admitted because of tumor in the petroclival area underwent preoperative clinical evaluation and imaging examinations to confirm Petroclival Meningioma. Dominant clinical signs were headache, paralysis, and cranial nerves dysfunction and balance disorders. The average duration of symptoms was40±35months. The mean tumor size was estimated to be46±11,5mm. The retro-sigmoid approach was the best approach in our series. All patients were registered and followed-up for improvement in neurological function, quality of life and tumor size by MRI. Possible prognostic factors that can affect tumor resection and tumor recurrence checked includes invasion of the cavernous sinus, size, type, brainstem compression, sex, age and preoperative clinical status.Results:Tumor resection was observed in58cases (68.24%) by Simpson II, only one postoperative death occurred, mortality being1.17%. In this group,74patients were followed up, mean duration being92months±57.5months. Among these patient (74),7deaths occurred for various reasons,4deaths due to failure of the meningioma resection while other3deaths were caused by other diseases. Among64patients monitored for quality of life by KPS Performance score, promising quality of life was observed in63cases (98.44%) meaning42cases (65.62%) with excellent quality of life(KPS Score=80-100) and20cases (31.25%) with good quality of life (KPS Score60-70) while lcase (1.56%) showed poor quality of life(KPS<60). Clinical and MRI imaging data revealed rate of tumor recurrence following total tumor resection to be6out of55cases (10.9%) and that of tumor progression after subtotal resection to be8out of19cases (42.2%). Univariate analysis of tumor resection was favorably influenced by any involvement of the cavernous sinus, small tumors, tumor type, and soft tumor while quality of life was positively affected by a high preoperative KPS score, no involvement of the cavernous sinus, soft tumor type and extent of resection.Conclusion:After the related difficulties in microsurgical treatment of petroclival meningiomas, the retrosigmoid approach is one of the most effective methods for total or subtotal resection of the tumor with a good prognosis vital to the long-term quality of life of patients undergoing surgery. Microsurgical resection of the tumor is also a function of the size, location, the texture, and the tumor adhesion to the cavernous sinus. The postoperative complications are more severe neurological dysfunction by which a negative impact on the quality of life long term. There are no significant correlations between long-term quality of life, tumor resection, size, location, type, consistency and compression of brainstem preoperative.