Surgical removal of small petroclival meningiomas.
Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial. Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas (diameter <or= 2.8 cm) treated with radical surgical removal. Total resection (Simpson's Grade 1) [43] was possible with minimal morbidity and no mortality.


BACKGROUND
We present a series of small petroclival meningiomas (SPM) treated by radical surgical removal and compare the outcome with other management modalities proposed for these lesions.


METHODS
Eighteen patients with SPM were surgically treated at our department of neurological surgery. The tumours were classified as small when they had a diameter < 3.0 cm. Headaches (n = 12), diplopia (n = 8), facial hypoaesthesia (n = 3) and tinnitus (n = 6) were the most frequent symptoms at presentation. The approaches used were retrosigmoid (n = 14), fronto-orbito-zygomatic (n = 3) and presigmoid (n = 1). The post-operative follow-up ranged from 1 to 110 months (mean 41.8 months).


RESULTS
Radical tumour resection (Simpson's Grades 1 and 2) was achieved in all patients. There was no major morbidity or mortality related to the surgical procedure. Transient abducent nerve palsy was the only post-operative complication. The pre-operative cranial nerves deficits improved after surgery. Only one patient had persistent diplopia postoperatively.


CONCLUSIONS
Radical surgical removal of SPM is possible with minimal morbidity and may cure the patient. The effectiveness and outcome of surgery for small petroclival meningiomas should be compared with series treated by radiosurgery.
Ramina
R
R
Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Brazil. ramina@inc-neuro.com.br
Neto
M C
MC
Fernandes
Y B
YB
Silva
E B
EB
Mattei
T A
TA
Aguiar
P H P
PH
D020434:Abducens Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003388:Cranial Fossa, Posterior; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010579:Petrous Bone; D011184:Postoperative Period; D016634:Radiosurgery; D020127:Recovery of Function; D012086:Reoperation; D019292:Skull Base Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome