title: Surgical management of medium and large petroclival meningiomas: a single institution's experience of 199 cases with long-term follow-up.
abstract: BACKGROUND
  Petroclival meningiomas (PCMs) were once regarded as 'inoperable' due to their complex anatomy and limited surgical exposure. This study aimed to evaluate the long-term outcomes of surgically treated PCMs larger than 2 cm.
  
  
  METHODS
  A series of 199 consecutive patients (137 females, 68.8 %) with PCMs larger than 2 cm from between 1993 and 2003 were included. The clinical charts, radiographs, and follow-ups were evaluated.
  
  
  RESULTS
  Gross total resection (GTR) was achieved in 111 (55.8 %) patients, subtotal resection (STR) in 65, and partial resection (PR) in 23. Cranial nerve dysfunctions were the most common complications and occurred in 133 (66.8 %) cases. The surgical mortality was 2.0 %. The Karnofsky Performance Scale (KPS) scores significantly decreased 1 month after the operations (preoperative KPS = 76.8 and postoperative KPS = 64.8; p = 0.011, Paired-samples t test). Long-term follow-ups were obtained in 142 patients, the follow-up duration was 171.6 months, and the most recent KPS was 83.2. Permanent morbidities remained in 24 patients (18.9 %). Multivariate analysis revealed that brainstem edema and tumors larger than 4 cm in diameter were independent risk factors in terms of outcomes (KPS < 80). The recurrence/progression rates were 14.5, 31.8, and 53.3 % for the GTR, STR, and PR cases, respectively (p = 0.002, Pearson χ (2) test). Gamma Knife radiosurgery for the remnants exhibited good tumor control.
  
  
  CONCLUSIONS
  Favorable outcomes and low mortality were achieved with the microsurgical management of medium and large PCMs; however, the rates of cranial nerves dysfunction remained high. Radically aggressive resection might not be judicious in terms of postoperative morbidity. The preoperative evaluations and intraoperative findings were informative regarding the outcomes. The low follow-up rate likely compromised our findings, and additional consecutive studies were required.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Brian Tumor, Beijing, China.
authors.forename: Da
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Brian Tumor, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Brian Tumor, Beijing, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Brian Tumor, Beijing, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Brian Tumor, Beijing, China.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng Distract, Beijing, 100050, People's Republic of China. zhangjunting2003@aliyun.com.|China National Clinical Research Center for Neurological Diseases, Beijing, China. zhangjunting2003@aliyun.com.|Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China. zhangjunting2003@aliyun.com.|Beijing Key Laboratory of Brian Tumor, Beijing, China. zhangjunting2003@aliyun.com.
authors.forename: Jun-Ting
authors.initials: JT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*
keywords: Meningioma; Microsurgery; Petroclival region; Radiosurgery; Skull base