Surgical management of clival meningiomas

The surgical management of intradural clival tumours is difficult due to the relative inaccessibility of the clivus through traditional neurosurgical approaches, and the intimate relationship of such tumours to critical neurovascular and brainstem structures. This report concentrates on the experience with clival meningiomas, which are the most common intradural clival tumours. Between July 1983 and July 1990, 52 patients with petroclival meningiomas underwent surgical excision of their tumours. A variety of skull base approaches were utilized to obtain wide tumour exposure with minimal brain retraction. Large or giant tumours required multiple approaches and staged removal of tumour. Tumour resection was evaluated by a standard protocol of postoperative MR or CT scans. Total tumour resection was achieved in 38 cases (73%), subtotal resection in 11 (21%) and partial resection in 3 (6%). Follow-up has ranged from 4 to 83 months. Two patients had recurrence of tumour requiring re-operation with one receiving additional external beam radiation. Two postoperative deaths occurred, one from pneumonia and another from infectious complications. The most common postoperative morbidity were lower cranial nerve palsy, aspiration peumonia and temporary hemiparesis.