Endoscope-assisted Transcranial Surgery for Petroclival Meningiomas: a Single Centre Experience.

Objective: The surgical management of petroclival meningioma (PCM) remains a challenge in neurosurgery. This study compared the outcomes of endoscope-assisted microsurgery and conventional microscopic approaches to evaluate the safety and efficacy of endoscope-assisted transcranial techniques for PCM treatment.

Methods: This retrospective case-control study was conducted at our hospital. Clinical data from January 2018 and June 2024 were retrospectively analysed. The primary outcome was gross total resection (GTR) rate, and the secondary outcomes included patient status, tumour progression or recurrence. Propensity score matching (PSM) was used to account for group differences.

Results: We enrolled 62 patients; 18 underwent endoscope-assisted transcranial surgery and 44 underwent transcranial microscopic surgery. The endoscope-assisted transcranial microsurgery group exhibited a higher GTR rate, shorter postoperative hospital stay, and lower tumour progression or recurrence rates than the transcranial microscopic surgery group (GTR: 83.3% vs. 52.3%, p = 0.046; postoperative hospital stay duration: 9.50 d [8.00, 13.75] vs. 13.00 d [10.00, 17.25], p=0.023; and lower tumour progression or recurrence: 11.1% vs. 50%, p = 0.01). After PSM, the endoscope-assisted surgery group had a better GTR rate, compared with the microsurgery group (odds ratio (OR): 7.51 [1.37, 41.10], 95% confidence interval: 1.37-41.10, p = 0.021).

Conclusion: Petroclival meningioma remains a surgical challenge. Endoscope-assisted microsurgery provides an increased GTR rate, offering excellent visualisation and access to tumours. Therefore, it may be recommended as a first-line treatment for patients with PCM.