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Ventral petrous meningiomas: unique tumors
1Brain Tumor and Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Introduction:
This study aims to analyze our experience with petrous meningiomas (PM), testing the hypothesis that these tumors have different histologic subtypes and operative outcome depending on the site of origin in reference to the internal auditory canal (IAC).
Methods:
Fifty-eight patients with PM were reviewed retrospectively. Tumors were classified as posterior (PPM; n = 29), superior (SPM; n = 8), and ventral petrous (VPM; n = 19), in reference to the IAC. Two patients had multiple meningiomas arising from different parts of the petrous bone. Petroclival, clival, and jugular tubercle meningiomas were excluded. All patients were operated through a suboccipital retrosigmoid approach. Clinical presentation, tumor size, involvement of IAC, extent of resection, outcome, and tumor histology were analyzed.
Results:
Simpson grade I and II resection was achieved in 84.5%: 96.6% in PPM, 100% in SPM, and 57.9% in VPM. Fibrous histology accounted for 69% in PPM, 62% in SPM, and only 10.5% in VPM, whereas meningothelial histology was seen 27.6%, 25%, and 68.4%, respectively. Postoperative hearing loss was the most frequent operative complication, and was seen in 31.6% of VPM, as compared to none in PPM or SPM.
Conclusions:
Ventral petrous meningiomas are clearly different tumors in their histology and operative outcome. The predominance of meningothelial histology in this location may imply a different tumorigenesis as compared to other PM. Ventral petrous meningiomas should be viewed as a distinct group of tumors.
Insights
Ventral petrous meningiomas (VPM) show distinct histology and outcomes compared to other petrous meningiomas (PM). VPM, often meningothelial, have poorer resection rates and higher complication risks like hearing loss.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Petrous meningiomas (PM) are tumors originating from the petrous bone.
- Understanding their subtypes based on location relative to the internal auditory canal (IAC) is crucial for surgical planning.
Purpose of the Study:
- To analyze surgical outcomes and histologic subtypes of petrous meningiomas.
- To test the hypothesis that tumor origin influences histology and operative results.
Main Methods:
- Retrospective review of 58 petrous meningioma patients.
- Classification into posterior (PPM), superior (SPM), and ventral petrous (VPM) groups based on IAC proximity.
- Analysis of clinical presentation, tumor characteristics, resection extent, outcome, and histology via suboccipital retrosigmoid approach.
Main Results:
- High Simpson grade I/II resection rates: 96.6% for PPM, 100% for SPM, 57.9% for VPM.
- Histology varied by location: PPM/SPM predominantly fibrous (69%/62%), VPM predominantly meningothelial (68.4%).
- Postoperative hearing loss was a significant complication in VPM (31.6%) but not PPM/SPM.
Conclusions:
- Ventral petrous meningiomas exhibit unique histology and surgical outcomes.
- The prevalence of meningothelial histology in VPM suggests potentially different tumorigenesis.
- Ventral petrous meningiomas warrant classification as a distinct tumor group.
