title: Combined petrosal approaches in the management of temporal bone meningiomas.
abstract: OBJECTIVE
  To evaluate the indications and outcomes of the combined petrosal approaches in the surgical management of temporal bone meningiomas.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Adults with temporal bone meningiomas.
  
  
  METHODS
  Meningioma removal using a combined petrosal approach.
  
  
  METHODS
  Cranial nerve outcomes, complications, completeness of resection, and recurrence rates.
  
  
  RESULTS
  Forty-nine patients underwent surgical excision of a temporal bone meningioma between 1996 and 2004 at our institution. Nineteen of these patients required a combined petrosal approach for excision. The most common presenting complaints were balance disturbance, 11 (58%); hearing loss, 10 (53%); headache, 10 (53%); and tinnitus, 9 (47%). The most common tumor origin was of the petrous ridge (14; 74%). Average tumor size was 3.1 cm. Complete resection was possible in 17 (89%) patients. Upper cranial nerve (III-VI) function was improved in two (11%) patients and worsened in three (16%) patients. Lower cranial nerve (IX-XII) function improved in one (5%) patient and was worsened in one (5%) patient. Postoperative facial nerve function was Grades I to II in 16 (84%) patients and Grades III to IV in 1 (5%) patient at last follow-up. Hearing data were available in 14 patients. Of those patients, 11 (85%) had serviceable hearing after surgery. The most common surgical complication was a cerebrospinal fluid leak, with three (16%) incidences. There were no reported incidents of stroke, death, or meningitis in the cohort.
  
  
  CONCLUSIONS
  The use of the combined petrosal approach for temporal bone meningioma resection results in favorable outcomes for the patient. The incidence of complications is acceptably low, and cure rates are high.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Baugh
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hillman
authors.forename: Clough
authors.initials: C
authors.lastname: Shelton
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000601:surgery; D008579:Meningioma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010579:Petrous Bone / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000473:pathology* / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology* / Q000601:surgery; D014717:Vertigo / Q000209:etiology