Extended Suboccipital Retrosigmoid Surgical Approach Is Effective for Resection of Petrous Apex Meningioma.
OBJECTIVE
The aim of this study was to evaluate the clinical features, treatment strategies, and outcomes of patients presented with petrous apex meningiomas.


METHODS
In this retrospective clinical study, 17 patients with petrous apex meningiomas were treated microsurgically via an extended suboccipital retrosigmoid approach. Data regarding the general characteristics of the patients, surgical management, and surgery-related outcomes were obtained by reviewing patients' medical records.


RESULTS
In the authors' study, the authors report that the use of an extended suboccipital retrosigmoid approach and careful microneurosurgical technique can be used to achieve improved surgical and functional outcomes. This was evidenced by gross tumor resection, which was confirmed in 12 (70.6%) patients, and by partial tumor resection, achieved in the remaining 5 patients. Using this surgical approach, the petrosal vein was preserved in 15 (88.2%) patients. In the remaining 2 (11.8%) patients, this vein was sacrificed. Postsurgical improvement of neurological deficits was consequently observed in 12 (70.6%) patients. Though 3 patients (17.6%) demonstrated a postoperative decline in neurological function, 1 patient significantly recovered facial function at follow-up. One patient with sacrificed petrosal vein experienced loss of functional hearing surgery with no recovery during the follow-up period. No operative mortality was observed. Total resection of petrous apex meningiomas is achievable using an extended suboccipital retrosigmoid approach without permanent surgery-associated neurological deficits in a majority of patients.


CONCLUSIONS
Our primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. Intraoperative protection of the petrosal vein should also be a surgical focus to avoid postoperative complications. Finally, stereotactic radiosurgery can also be useful as a supplemental treatment for postoperative tumor residuals.
Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Hua
H
Cui
Cai-Fang
CF
Zhou
Ying-Hui
YH
Bao
Ming-Sheng
MS
Wang
Yong
Y
Wang
D000328:Adult; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D054064:Transverse Sinuses; D016896:Treatment Outcome