F8.04 petroclival meningioma-the role of skull base approaches in their surgical management

Thirty-one cases of petroclival meningioma have been operated on during a 4-year period using 2 different approach philosophies. Group A patients ( 13 cases) have been operated on using either a subtemporal transtentorial or a retrosigmoid approach. Group B patients ( 18 cases) have been managed using a lateral skull base approach, either the anterior transpetrosal or the presigmoid approach. Translabyrintine/transcochlear approaches were used more frequently, but not exclusively, in more recent cases. Tumour dissection and removal appeared to be easier in skull base operated patients. However, operations take longer and surgical complications such as CSF leak and hearing loss were increased. Radical tumour removal could be achieved in an equal percentage of cases of both groups (77 % vs 83 %). Early postoperative course was more favourable in Group B patients. Skull base approaches facilitate tumour dissection and removal at the expense of more surgical complications. However, the widened surgical field and increased angle of approach that skull base surgery techniques may offer play a significant role in the removal of sizeable, infiltrative and/or recurrent petroclival meningiomas.