title: Outcomes of Endonasal and Lateral Approaches to Petroclival Meningiomas.
abstract: OBJECTIVE
  Transpetrosal approaches for the treatment of petroclival meningiomas are often associated with substantial morbidity and long recovery. With the goal of early clinical improvement, we have used less invasive surgical approaches for petroclival meningiomas.
  
  
  METHODS
  We retrospectively reviewed 32 patients with petroclival meningiomas. Eleven patients (34.4%) were managed with lateral approaches (retrosigmoid or far lateral approach), 17 (53.1%) with anterior midline approaches (endoscopic endonasal approach [EEA]), and 4 (12.5%) with a combination.
  
  
  RESULTS
  The average Karnofsky Performance Score (KPS) at presentation was 73.8. The average postoperative KPS improved to 87.9 (P < 0.001) during short-term follow-up of 14 months (range, 1-42) and was significantly higher in primary tumors (P = 0.013), tumors <4 cm (P = 0.039), and tumors without vascular encasement (P = 0.002) but remained significant regardless of age, tumor size, or vascular encasement. The greatest benefit occurred with primary tumors, in young patients and in those who underwent nontotal resection (P < 0.001). EEA had a significantly greater potential for improved KPS (P = 0.002). Gross (n = 6) or near total (n = 9) resection was achieved in 15 of 32 cases (47%). Complications included new cranial nerve palsies affecting mainly the abducens nerve (18.7%). New lower cranial nerve palsies occurred in only 1 case (3.1%). Other complications included postoperative hydrocephalus (15.6%) and cerebrospinal fluid leak (28.1%). One patient died in the perioperative period (3.1%).
  
  
  CONCLUSIONS
  In the short-term, less aggressive cranial base approaches, including retrosigmoid exposures and the recently introduced EEA, are effective alternatives to transpetrosal approaches for debulking petroclival meningiomas with significant early clinical improvement and limited major surgical complications.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Koutourousiou
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vaz-Guimaraes Filho
authors.affiliation: Department of Otolaryngology, University of Toronto, Toronto, Canada; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: gardpa@upmc.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000368:Aged; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D010579:Petrous Bone / Q000601:surgery*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endoscopic endonasal; Karnofsky Performance Score; Petroclival meningioma; Postoperative morbidity; Retromastoid; Retrosigmoid approach