Petroclival tumour surgery: a personal experience of 20 cases

ABSTRACT

petroclival lesions are amongst the most difficult lesions in Neurousrgery and carry a significant mortality and morbidity. However, over the last decade, publications from specialized centers have reported on the outcome of surgery for these lesions. we have analysed 20 patients, who had undergone surgery for petroclival tumour in general neurosurgical center over a 3-year-period [January 1997- December 1999]. there were 10 meningiomas, 5 chordomas, 3 trigeminal neurofibromas and 2 giant cell tumours. Seventeen patients had primary surgery while 3 had surgery for recurrent lesions. Investigations included CT scan, MRI and DSA or MRA in all patients. Ten patients were operated through retromastoid post-sigmoid approach, 7 through subtemporal combined with orbito-zygomatic approach and 3 were operated through combined retromastoid and subtemporal approach. There were two deaths. One was primarily related to surgery and the other due to respiratory complications. Six patients developed postoperative chest infection and 3 postoperative haematoma, of whom only 1 required surgical evacuation. Postoperative meningitis was recorded in 2 patients. Follow-up ranged from 9 months to 36 months with a mean of 21 months. None of the patients have, so far, developed recurrence or re-growth significant enough to merit a re-operation. tumour could not be removed totally in a significant number of cases inspite of all advances. Radiosurgery is an important adjuvant in the management of residual and recurrent lesions. Outcome was not different when compared to a specialized Neurousurgery unit