Posterior fossa meningioma "our experience" in 64 cases

Posterior fossa meningiomas are 20% of all intracranial meningiomas. These are slow-growing tumors thus become large before presentation. Microsurgical resection is the treatment of choice for the majority of these lesions, but variable locations, large size at diagnosis, frequent encroachment of neural and vascular structures, and their potentially invasive behavior are some of the features of these tumors that make their resection challenging.

We studied 64 cases of posterior fossa meningioma operated in last 6 years, and analysed the technical difficulties encountered during excision of these tumors. Postoperative complications and outcomes of these patients were also analysed.

Gross total excision was achieved in 72% cases. Partial excision or subtotal excision was more in petroclival, jugular foramen with extra cranial extension, tentorial with intrasinus extension and ventral foramen magnum. Postoperative complication in form of new or aggravation of existing neurological deficit was found in 33% cases and CSF leak in 12.5% cases. We encountered the recurrence of total 10 cases (16%) over mean follow-up of 4 years. Most of the recurrent cases were seen in petroclival and tentorial subgroups with partial or subtotal excision.

Posterior fossa meningiomas are difficult to excise due to close relation to cranial nerves and vessels. Use of microscope, CUSA, intraoperative nerve monitor help in removal and preserving surrounding important anatomical structures. Although neurological deterioration is common postoperatively, recovery does occur completely after total removal thus increasing the recurrence free period and improving the outcome.