The selection of the optimal therapeutic strategy for petroclival meningiomas

Broad experience with the management of petroclival meningiomas was analyzed to optimize therapeutic strategy.

The records of 75 patients with petroclival meningioma were reviewed. The population was divided into a microsurgery group (n = 49), a radiosurgery group (n = 12), a radiation therapy group (n = 5), and an observation group (n = 9) according to the modality of primary treatment. In the microsurgery group, the tumor was completely resected in 10 patients. Eleven of the 39 patients with incomplete resections sequentially underwent adjuvant radiation therapy or radiosurgery. The median follow-up period was 86 months (range, 48-210 months). The median follow-up period of the radiosurgery, the radiation therapy, and the observation group was 52 months (range, 48-71 months), 56 months (range, 51-72 months), and 63 months (range, 53-68 months), respectively. Management outcomes were evaluated with respect to tumor control rate, neurological deficit, and functional status assessed by the Karnofsky Performance Score.

In the microsurgery group, 11 (22.4%) patients eventually showed tumor progression. However, there was only one recurrence if adjuvant therapy was used after incomplete removal. The incidence of favorable outcomes for cranial neuropathies was better in the incomplete resection group (69.2%) than for patients in the complete resection group (20%, P = .032). Moreover, a favorable functional outcome predominated in the incomplete resection group (76.9%) compared with the complete resection group (30%, P = .049). The disease was stable in both the radiation therapy and the radiosurgery groups during the follow-up period, with functional status and cranial nerve function perfectly preserved in these patients. No predictive factor other than short symptom duration was found to be significant.

Because the growth rate of petroclival meningioma is low and good functional status can be guaranteed, intended incomplete resection should be considered as an acceptable treatment option. Adjuvant treatment after surgery is useful in the control of residual tumors. Radiosurgery may be appropriate as the primary treatment in asymptomatic patients with small tumor; however, more aggressive treatment is needed in young patients or patients with short symptom durations.