title: Surgical management of petroclival meningiomas: Factors affecting early post-operative outcome.
abstract: BACKGROUND
  Petroclival meningiomas pose a major challenge to the treating neurosurgeon. The philosophy of treatment has changed over the decades from a nihilistic attitude to that of aggressive total excision to now a more tempered, maximal safe excision preventing morbidity followed by adjuvant treatment. Despite the advances in neurosurgery, surgical management of these tumours is still associated with sizable morbidity and mortality.
  
  
  METHODS
  This is a retrospective study of surgically managed petroclival meningiomas at our institute. Clinical status, radiological features and surgical outcome were analysed.
  
  
  RESULTS
  Between January 2003 and August 2013, we have operated on 30 patients. The most common presenting complaints were varying degrees of cranial nerve involvement and cerebellar dysfunction. Surgery was done using one of the skull base approaches with the retrosigmoid approach being used maximally (22 cases). Total or near-total excision was possible in 11 cases. There was a post-operative deterioration in cranial nerve functions in all patients and deterioration in Karnofsky Performance Score in seven patients at discharge. Three improved to independent status on follow-up. There was mortality in two cases. Overall 23 of the 30 patients (76.6%) had favourable outcomes.
  
  
  CONCLUSIONS
  These are challenging tumours to treat and are associated with sizable morbidity and mortality. On statistical analysis, we found that if the tumour has a size of 3-5 cm and petroclival in location with no sphenoid extension and the lesion is homogenous on T2-weighted images, then there was a trend towards gross total resection and favourable outcome.
authors.affiliation: a Department of Neurosurgery , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India.
authors.forename: Manish
authors.initials: M
authors.lastname: Beniwal
authors.forename: Dhananjaya I
authors.initials: DI
authors.lastname: Bhat
authors.forename: Narasinga
authors.initials: N
authors.lastname: Rao
authors.forename: Indira Devi
authors.initials: ID
authors.lastname: Bhagavatula
authors.forename: Sampath
authors.initials: S
authors.lastname: Somanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017063:Outcome Assessment, Health Care; D011859:Radiography; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: conservative resection; meningiomas; petroclival; retrosigmoid; skull base