Surgical management of posterior cranial fossa meningiomas

Seventy-three patients with posterior fossa meningioma were operated upon between July 1975 and September 1992. The authors attempt a simple classification of these tumours. Fifty-five were women (average age: 48 years) and 18 were men (average age: 52 years). Frequently, there was gait disturbance except in tentorial meningioma where headache was the most common symptom. The most common physical finding was a cranial nerve deficit (77%). All patients underwent CT and angiography. More recently, MRI was used and found very helpful. Surgical approaches used were either a suboccipital craniectomy, a subtemporal craniotomy or a combined suboccipital-subtemporal approach. Tumour resection was complete in 57 (78%) cases. There were no operative deaths. Thirty-three per cent of patients were left with permanent deficits: mainly cranial nerve deficit (47%). Seventy-seven per cent of patients out of the 57 who could be followed up are functioning independently, 21% of these having no neurological deficit. With proper neuroradiological evaluation, good selection of patients and microneurosurgical techniques posterior fossa meningiomas can be completely excised with an acceptable complication rate.