title: Novel classification for surgical approach of petroclival meningiomas: A single-surgeon experience.
abstract: BACKGROUND
  Management of petroclival meningiomas (PCMs) is a surgeons' challenge. Planning the surgical approach and extent of excision play a vital role. The current study discusses a novel grading system that may help to choose the surgical approach.
  
  
  METHODS
  We prospectively analyzed 76 patients operated after selecting the surgical approach through a novel grading system based on the extent of dural attachment of PCM in the posterior fossa.
  
  
  RESULTS
  The mean age of the study group was 39.74 ± 13.38 years and 51% of the patients were women. Gross total resection (GTR) was achieved in 59 (77.6%) patients. Among patients who underwent subtotal resection (STR), the mean sagittal diameter of the tumor was greater than axial (4.6 ± 0.9 mm vs. 3.4 ± 1.3 mm; P = 0.01) and coronal diameters (4.6 ± 0.9 mm vs. 3.8 ± 1.4 mm; P < 0.01). The complication rate was 34.2%. The most frequent complication was cerebrospinal fluid leak in 10 (13.1%) patients. In patients where STR was done, the sagittal diameter of the tumor was higher in patients without complications (4.5 ± 0.9 mm vs. 3.9 ± 1.1 mm; P = 0.02). At 6 years follow-up, 6 patients where STR was performed, developed tumor progression.
  
  
  CONCLUSIONS
  The proposed grading is helpful in achieving higher rates of GTR with minimal complications in surgical excision of PCMs. The role of sagittal diameter in planning the extent of excision needs further research.
authors.affiliation: Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
authors.forename: Manas
authors.initials: M
authors.lastname: Panigrahi
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.forename: Mohan Rao
authors.initials: MR
authors.lastname: Patibandla
authors.forename: Dilip
authors.initials: D
authors.lastname: Kulkarni