Microsurgical Treatment And Clinical Analysis Of Petroclival Meningiomas

Objective:To evaluate and analyze the therapeutic outcomes of microsurgical removal of petroclival meningiomas(PCMs),and investigate relative factors which may affect the extent of tumor resection and prognostic factors may affect further quality of patient life in order to explore the individual surgical strategy of petroclival meningiomas,improving the resection rate of the tumor,decreasing the mortality rate,disability rate and recurrence rate,and in order to improve the patient prognosis and further quality of life.Material and Method:Retrospectively analyzed clinical and follow-update in a consecutive series of 36 patients who underwent microsurgical treatment for petroclival meningiomas at Neurosurgery Department of Shandong provincial hospital between Jan 2008 and Dec 2017.There were 10 males and 26 females(ratio,1:2.6)with a mean age of(49.3 ± 12.7)years(range 24?75 years).The main initial clinical symptoms were including headache,diplopia,facial numbness,facial pain,tinnitus,hearing loss,walking instability and so on.Surgical approaches were utilized including 8cases with subtemporal transtentorial approach,8 cases with presigmoid approach,and 20 cases with suboccipital retrosigmoid approach.Records of all follow-up patients including clinical history,preoperative postoperative functional state,image results,surgical outcomes tumor characteristic were all detailed collected.Analyze possible prognostic factors which may affect the extent of tumor removal,prognostic quality of life and long-term survival rate,including cavernous sinus compression,sex,age,invading,tumor size,tumor type,brain stem preoperative status.Results:In 36 cases,gross total resection of tumor(GTR)was reached in 22cases(61.1%).The subtotal removal(STR)achieved in 8 cases(22.2%).The partial removal(PR)was 6 cases(16.7%).There was no case died during the surgery and preoperative period.Postoperative complications appeared in 12 cases(33.3%),included intracranial infection in,pulmonary infection,intracranial hematoma and cerebrospinal fluid leaked..The new neurological dysfunction appeared in 17 cases(47.2%)postoperatively,including oculomotor paralysis,trigeminal nerve deficits,abducent paralysis,facial paralysis,posterior cranial nevers deficits and so on.All 36 patients get followed-up,with a mean period of(31.4±17.5)months(range 1-62 month),and excellent quality of life in 28 cases(77.8%),good quality of life in 7 cases(19.4%),poor quality of life in 1cases(2.8%).Tumor recurrence was identified in 4 cases(18.2%)in 22 cases of GTR.Tumor progress was identified in 4 cases(28.6%)in 14 cases of nGTR which got followed up including 3 cases(50%)who never received any postoperative treatment and 1 case(12.5%)who received postoperative ?-knife treatment.Univariate statistical analysis and Multivariate statistical analysis showed that the extent of tumor removal were related with the factors of tumor texture,whether to invade into cavernous sinus,whether to wrap neurovascular structures and the degree of compression of the brainstem.The prognosis of further quality of life were related with the factors of tumor subtype,whether to wrap neurovascular structures,the degree of brainstem edema and the extent of tumor resection.Conclusions1.It is helpful to realize the gross total resection of petroclival meningiomas the characteristics and tumor classification of petroclival meningiomas.And suboccipital retrosigmoid-transtentorial approach is a securer and more effective approache.2.The extent of tumor removal is related with the factors of tumor texture,whether to invade into cavernous sinus,whether to wrap neurovascular structures and the degree of compression of the brainstem3.The prognosis of further quality of life are related with the factors of tumor subtype,whether to wrap neurovascular structures,the degree of brainstem edema and the extent of tumor resection.4.The remnant of tumor postoperatively can be controlled effectively by ?-knife treatment to get low rate of tumor progression.5.Neurosurgeon should take sufficient preoperative assessment,clearing the factors relating to the extent of tumor resection and the prognosis of further quality of life and choosing an appropriate surgical approach to make a reasonable and effective treatment strategy.Neurosurgeon should increase the extent resection in the case of preserving vascular,nerve and other important structures,which will reduce postoperative morbidity and improve quality of patient's life.