Transpetrosal approaches for meningiomas of the posterior aspect of the petrous bone Results in 43 consecutive patients.
OBJECTIVE
To assess outcome following excision of meningiomas of the posterior aspect of the petrous bone through transpetrosal approaches.


METHODS
We carried out a retrospective case-series study in a multidisciplinary tertiary care center on all patients who underwent meningiomas removal from January 1989 to September 2005. Surgical approaches were transpetrosal: widened retrolabyrinthine, translabyrinthine, transotic and transcochlear, occasionally combined with a subtemporal transtentorial approach. Epidemiology, symptoms, preoperative evaluation, surgery, postoperative complications and facial and auditory results were analyzed using standardized grading systems. The Desgeorges and Sterkers classification was used to assess tumor size and location.


RESULTS
Forty women and three men underwent surgery (mean age: 56.7). Medium-sized tumors stages 2 and 3 (84%) and AM and P localization (34% and 20.4%) predominated. In 65% of cases, the tumor extended beyond the CPA. Main presenting symptoms were balance disorders (72%) and sensorineural hearing loss (53.5%). Mortality was nil. A preoperative facial nerve paresis was present in 14% of patients. Tumor removal was complete in 79.1% of cases. At 1-year post-op, 73% of patients had a normal or subnormal facial function and 55% had serviceable hearing. A cerebrospinal fluid leakage occurred in 6.9%.


CONCLUSIONS
Posteriorly attached meningiomas are less symptomatic and of better prognosis than medially inserted ones. Transpetrosal approaches are reliable for the removal for all types and sizes of such tumors, and can be easily combined in the same procedure with a subtemporal transtentorial approach to remove extensions to the clivus and tentorium. They offer low morbidity and a high proportion of facial nerve and hearing preservation.
Devèze
Arnaud
A
Department of Otolaryngology and Skull Base Surgery, Nord University Hospital, University of Marseille-Méditerranée, Marseille F-13000, France. arnaud.deveze@ap-hm.fr
Franco-Vidal
Valérie
V
Liguoro
Dominique
D
Guérin
Jean
J
Darrouzet
Vincent
V
D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D003051:Cochlea / Q000601:surgery; D007758:Ear, Inner / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010579:Petrous Bone / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation