The evolution of surgical approaches for posterior fossa meningiomas.
OBJECTIVE
To evaluate surgical outcomes for the treatment of posterior fossa meningiomas at the House Ear Clinic from 1987 to 2001. We review our current treatment algorithm and present our postoperative outcomes with attention to facial and auditory neural preservation.


METHODS
Retrospective review.


METHODS
Tertiary care center.


METHODS
Medical records of 71 patients who underwent posterior fossa meningioma surgery at the House Ear Clinic were reviewed.


METHODS
All patients had surgical removal of their meningioma via translabyrinthine, transcochlear, retrosigmoid, extended middle fossa, or combined petrosal approaches by House Ear Clinic neurotologists and neurosurgeons.


METHODS
Preoperative and postoperative auditory and facial nerve function data were collected. Patient and tumor characteristics including presenting symptoms, completion of tumor resection, and complications secondary to surgery were also recorded.


RESULTS
The most common presenting symptoms in this series were otologic, with hearing loss (61%), tinnitus (58%), and imbalance (58%) as the three most common. Gross total resection was achieved in 67 (94%) patients. Hearing-preservation surgery was attempted in 37 (52%) patients (68% via extended middle fossa or combined approach). Twenty-one patients with preoperative Class A hearing had follow-up audiometric data and 18 (86%) had serviceable hearing preserved. Excluding transcochlear craniotomies, 85% of patients had normal facial nerve function postoperatively. Cerebrospinal fluid leak (6%) was the most common complication.


CONCLUSIONS
Advances in microsurgical techniques have greatly changed our management of patients with posterior fossa meningiomas. These changes have reduced postoperative morbidity. Specifically, use of the anterior and posterior petrosal approaches has facilitated facial and auditory neural preservation while not compromising the extent of tumor excision.
Shen
Ted
T
House Ear Clinic, House Ear Institute, and University of Southern California Keck School of Medicine, Los Angeles, California, USA.
Friedman
Rick A
RA
Brackmann
Derald E
DE
Slattery
William H
WH
Hitselberger
William E
WE
Schwartz
Marc S
MS
Fisher
Laurel
L
D000465:Algorithms; D003056:Cochlear Nerve / Q000502:physiology; D003388:Cranial Fossa, Posterior / Q000601:surgery; D005154:Facial Nerve / Q000502:physiology; D005155:Facial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome