Petroclival meningioma. The role of skull base approaches in their surgical management.

31 cases of petroclival meningioma have been operated on during a 4-year period using two different philosophies as far as the approach. Group A patients ( 13 cases) have been operated on using mostly 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 were used more frequently, but not exclusively, in more recent cases. Tumor dissection and removal appeared to be easier in skull-base operated patients. However operations take longer time and surgical complications such as CSF leak and hearing loss were increased. Radical tumor removed 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 tumor dissection and removal at the expenses of increased surgical complications. However the widened surgical field and increased angle of approach that the techniques of skull base surgery may offer can play a significant role in the removal of sizeable, infiltrative and/or recurrent petroclival meningiomas.