title: Posterior petrous face meningiomas: an algorithm for surgical management.
abstract: OBJECTIVE
  The objective of the present study was to report our surgical strategy in the management of 81 patients with posterior petrous face meningiomas.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  This study was conducted at a quaternary private otology and cranial base center.
  
  
  METHODS
  Of 139 patients with posterior fossa meningioma, 81 occurred on the posterior petrous face of the temporal bone and were the object of this study.
  
  
  METHODS
  Thirty-one patients were approached by the enlarged translabyrinthine approach. The enlarged translabyrinthine approach with transapical extension Type II was performedin 29 patients. The combined retrosigmoid-retrolabyrinthine approach was chosen in 8 cases. The modified transcochlear approach Type A with permanent posterior transposition of the facial nerve (FN) was performed in 6 patients. Two patients underwent a retrolabyrinthine subtemporal transapical approach. One patient underwent a transpetrous middle cranial fossa approach. Four patients with intracanalicular meningiomas were operated on through the enlarged middle cranial fossa approach.
  
  
  RESULTS
  Total removal of the tumor (Simpson Grades I and II) was achieved in most patients (92.5%). The FN was anatomically preserved in 79 of the 81 (97.5%) patients. Five patients had less than 1 year follow-up, and 2 patients were lost to follow-up and were excluded in evaluation of the final FN outcome. At 1-year follow-up, 46 patients (63%) had Grade I to II, 19 (26%) had Grade III, 4 (5.4%) had Grade IV, 1 (1.3%) had Grade V, and 3 (4.1%) had Grade VI. Hearing-preserving surgery was attempted in 15 patients (18.5%) with preoperative serviceable hearing. Of these 15 patients, 11 had their hearing preserved at the same preoperative level, and 4 experienced postoperative deafness. Postoperatively, a new deficit of 1 or more of the lower cranial nerves was recorded in 3 patients. One patient experienced subcutaneous cerebrospinal fluid collection that required surgical management.
  
  
  CONCLUSIONS
  Total tumor removal (Simpson Grades I-II) remains our treatment of choice and takes priority over hearing preservation. Subtotal resection is indicated for older and debilitated patients with giant lesions to relieve the tumor compression on the cerebellum and brainstem. Subtotal removal is also preferred in the face of the absence of a plane of cleavage between the tumor and the brainstem, in the presence of encasement of vital neurovascular structures, in elderly patients with tumors adherent to preoperatively normal facial or lower cranial nerves.
authors.affiliation: Gruppo Otologico, Piacenza-Rome, Italy. mario.sanna@gruppootologico.it
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacciu
authors.forename: Enrico
authors.initials: E
authors.lastname: Pasanisi
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Taibah
authors.forename: Paolo
authors.initials: P
authors.lastname: Piazza
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003051:Cochlea / Q000601:surgery; D007758:Ear, Inner / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D015192:Infratentorial Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008579:Meningioma / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D010579:Petrous Bone / Q000473:pathology*; D012189:Retrospective Studies; D014012:Tinnitus / Q000209:etiology; D014717:Vertigo / Q000209:etiology