Comparative analysis of facial nerve outcomes in petroclival versus posterior petrous meningioma surgery: A systematic review and meta-analysis of 2884 patients

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-27 DOI:10.1016/j.jocn.2025.111426

Mehdi Khaleghi , Matthew Tao , Garrett Dyess , Danner W. Buttler , Adnan H. Shahid , Sudhir Suggala , Ursula Noelle Hummel , Maxon Bassett , Jeffrey Sosnowski , Jai Deep Thakur

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引用次数: 0

Abstract

Background

Even conservative resection of petroclival (PC) and posterior petrous (PP) meningiomas may cause facial nerve (FN) morbidities. While inconsistent classifications by tumor’s dural origin circulate among different cohorts, a comprehensive assessment of postoperative FN outcomes is lacking. We systematically evaluate early and long-term FN outcomes related to surgical extirpation of PC and PP meningiomas.

Methods

A PRISMA-tailored survey of PubMed, Embase, Ovid/Medline, and Scopus was used to assess pooled perioperative FN deficit rates in PC and PP meningiomas. Outcomes were dichotomized by tumor’s dural origin (PC vs. PP group), age (≥50 vs. < 50 years), and tumor size (≥ 3.5 vs. < 3.5 cm), and analyzed using random-effect meta-analysis.

Results

Forty-one studies involving 2884 patients with an average tumor size of 3.5 cm met the eligibility criteria. Pooled gross total resection rates were 48 % for PC and 69.6 % for PP groups. FN deficits rates (HB grade > II) at presentation, early postoperative (new-onset during admission), and long-term (≥6-month follow-up) were respectively 12 % (CI:7.7–16.3 %; p < 0.001; I² = 89.7 %), 18.6 % (CI:14–23.2 %; p < 0.001; I² = 89.9 %), and 8.3 % (CI:5–11.7 %; p < 0.001; I² = 87.3 %) in “PC group”, and 6.4 % (CI 3.8–9 %; p < 0.001; I² = 79.4 %), 16.2 % (CI:10.3–22.2 %; p < 0.001; I² = 89.4 %), and 9.2 % (CI:3.9–14.5 %; p < 0.001; I² = 91.2 %) in “PP group.” The mixed-effect model revealed significantly higher FN deficit rates at presentation for larger PP meningiomas (15.9 % in size ≥ 3.5 cm vs. 5.8 % for < 3.5 cm, p = 0.003), while larger PC meningiomas had higher early postoperative rates (18.1 % vs. 3.9 %, respectively, p < 0.001). Tumor size, age, or dural origin did not impact overall long-term outcomes.

Conclusions

No significant difference was observed in long-term FN outcomes between PC and PP meningiomas. Anatomic preservation of the nerve should be prioritized regardless of tumor size, approach, or dural origin, as many deficits improve in the long-term. Although challenging, in meningiomas ≥ 3.5 cm, preoperative detailing of the dural origin is of value in patient consultation, as larger sizes worsen “early” FN outcomes only in true PC meningiomas.

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岩斜坡与后岩脑膜瘤手术面神经预后的比较分析：2884例患者的系统回顾和荟萃分析

背景：即使保守切除岩斜坡（PC）和岩后（PP）脑膜瘤也可能引起面神经（FN）发病。在不同的队列中，肿瘤的硬脑膜来源分类不一致，缺乏对术后FN结果的综合评估。我们系统地评估与手术切除PC和PP脑膜瘤相关的早期和长期FN结果。方法采用PubMed、Embase、Ovid/Medline和Scopus进行prism定制调查，评估PC和PP脑膜瘤围手术期FN缺失率。结果根据肿瘤的硬脑膜来源（PC组vs. PP组）、年龄(≥50组vs. lt组；50岁)，肿瘤大小(≥3.5 vs. <；3.5 cm)，采用随机效应荟萃分析进行分析。结果41项研究2884例患者符合入选标准，平均肿瘤大小为3.5 cm。PC组和PP组的总总切除率分别为48%和69.6%。FN赤字率(HB等级>；II)入院时、术后早期（入院时新发）和长期（随访≥6个月）分别为12% (CI:7.7 - 16.3%；p & lt;0.001;I2 = 89.7%), 18.6% (ci:14 - 23.2%；p & lt;0.001;I2 = 89.9%)和8.3% (CI:5 - 11.7%；p & lt;0.001;I2 = 87.3%)在“电脑集团”,和6.4% (-9% CI 3.8;p & lt;0.001;I2 = 79.4%), 16.2% (ci:10.3 - 22.2%；p & lt;0.001;I2 = 89.4%)和9.2% (CI:3.9 - 14.5%；p & lt;0.001;I2 = 91.2%)。混合效应模型显示，较大PP脑膜瘤呈现时FN缺失率显著较高(≥3.5 cm为15.9%,≥3.5 cm为5.8%；3.5 cm, p = 0.003)，而较大的PC脑膜瘤术后早期发生率较高(分别为18.1%比3.9%,p <；0.001)。肿瘤大小、年龄或硬脑膜来源对总体长期预后没有影响。结论PC脑膜瘤与PP脑膜瘤的远期FN预后无显著差异。解剖保存神经应优先考虑肿瘤大小、入路或硬脑膜来源，因为许多缺损在长期内会改善。尽管具有挑战性，但在≥3.5 cm的脑膜瘤中，术前详细检查硬脑膜起源在患者咨询中是有价值的，因为较大的尺寸只会使真PC脑膜瘤的“早期”FN结果恶化。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.