Early surgical outcome of petroclival meningiomas: a single-center case series from Vietnam

Abstract

Objective

Petroclival meningiomas have been regarded as among the most difficult skull base lesions to operate. This study evaluated the early surgical outcome of petroclival meningiomas at one of the largest neurosurgery centers in Vietnam.

Methods

A series of 38 patients (28 females and 10 males) with petroclival meningiomas operated as the primary treatment from January 2021 to January 2023 were prospectively studied. Data was collected during patient hospitalization period and follow-ups at one month and six months after discharge.

Results

The mean preoperative Karnofsky Performance Scale (KPS) score was 75.53 and 26/38 (68.4 %) patients presented with cranial nerve deficits. The mean tumor equivalent diameter was 34.5 mm and 6 (15.8 %) cases demonstrated extensions into adjacent regions. Gross total resection (GTR) was achieved in 36.8 % of patients. Hyperintensity on MRI T2-weighted images was associated with a higher rate of GTR. 12/38 (31.6 %) patients had postoperative complications with 3 (7.9 %) hospital mortalities. Complications included 2 (5.3 %) intracranial hemorrhage, 1 (2.6 %) brainstem infarction, 1 (2.6 %) diffuse brain edema, 1 (2.6 %) newly developed hydrocephalus, 2 (5.3 %) cerebrospinal fluid leak, 2 (5.3 %) meningitis, 1 (2.6 %) surgical site infection, 3 (7.9 %) pneumonia and 6 (15.8 %) underwent tracheotomy. Headache, dizziness, limb weakness, ataxia, sensory disturbance, and sphincter dysfunction showed remarkable improvement, whereas CN dysfunction exhibited varying pattern of progression. 14/35 (40 %) patients developed new or exacerbation of preoperative neuropathies which mainly involved cranial nerves VI (14.3 %), VII (22.9 %), and VIII (14.3 %). The mean KPS score decreased to 69.21 at the 1-month follow-up and then improved to 74.47 six months after surgery. Follow-up MRI demonstrated one case with tumor recurrence after total resection and another case with lesion progression following subtotal resection.

Conclusions

Petroclival meningiomas remain as surgically challenging lesions. Despite limited resectability, surgery offers early favorable results. Hyperintensity on MRI T2-weighted image facilitates gross total resection.