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Posterior petrous face meningiomas: an algorithm for surgical management
Mario Sanna1, Andrea Bacciu, Enrico Pasanisi
1Gruppo Otologico, Piacenza-Rome, Italy. mario.sanna@gruppootologico.it
Summary
This study highlights surgical strategies for posterior petrous face meningiomas, achieving high rates of total tumor removal and facial nerve preservation. Subtotal resection is reserved for specific cases in older patients or when vital structures are involved.
Area of Science:
- Neurosurgery
- Otolaryngology
- Cranial Base Surgery
Background:
- Meningiomas of the posterior petrous face present unique surgical challenges.
- Effective management requires specialized approaches to ensure maximal tumor resection and preservation of neurological function.
Purpose of the Study:
- To detail the surgical strategies employed for 81 patients diagnosed with posterior petrous face meningiomas.
- To evaluate the outcomes of these surgical interventions, focusing on tumor removal extent and neurological preservation.
Main Methods:
- A retrospective analysis of 81 patients with posterior petrous face meningiomas treated at a specialized cranial base center.
- Various surgical approaches were utilized, including enlarged translabyrinthine, translabyrinthine with transapical extension, retrosigmoid-retrolabyrinthine, and modified transcochlear approaches.
Main Results:
- Total tumor removal (Simpson Grades I and II) was achieved in 92.5% of patients.
- The facial nerve (FN) was anatomically preserved in 97.5% of cases.
- Hearing preservation was successful in 11 of 15 attempted cases (73.3%), with 3 patients experiencing new lower cranial nerve deficits and 1 with cerebrospinal fluid collection.
Conclusions:
- Total tumor removal (Simpson Grades I-II) is the primary treatment goal, prioritizing it over hearing preservation.
- Subtotal resection is a viable option for elderly or debilitated patients with giant tumors or when adherence to critical neurovascular structures precludes complete resection.
