Keyhole approach surgery for petroclival meningiomas / 中华显微外科杂志

ABSTRACT

Objective To evaluate the possibility of keyhole approaches for surgical treatment of petroclival meningiomas. Methods We retrospectively analyzed our experience in 14 cases with petroclival meningiomas surgically treated from May 2003 to January 2004. Eight tumors involved the upper and middle clivus.five tumors were attached to the entire width of clivus and one tumor involved the middle and lower cilvus. The tumors infiltrated into parasella regions or cavernous sinus in six cases simultaneously. Retrosigmoidal keyhole approach was selected to remove the tumors in 6 cases, and subtemporal keyhole approach was selected in 2 cases,while the combined retrosigmoidal and subtemporal keyhole approaches were applied in other six cases. Results Gross total resections of the tumors were achieved in 8 cases, subtotal resections in 4 cases, large resection in two cases who had recurrent tumors. Postoperatively, neurological intact or unchanged were found in 8 cases. The main surgical complications were mild facial palsy (4 cases) , abducent dificits (3 cases) ,temporary oculomotor nerve dificits (2 cases),and lower cranial nerve palsy (1 case). One patient died from disseminated intravascular coagulation (DIC) two weeks after surgey. There were no CSF leakage and infections after surgery in all cases 11 to 19 months follow-up studies demonstrated the great improvement of the Ⅲ and Ⅶ nerve deficits,but minor improvement in the Ⅵ nerve deficits. Conclusion According to the location and extension of the tumors, retrosigmoidal or subtemporal keyhole approaches or their combined can be selected for surgical treatment. These keyhole approaches can expose sufficiently the petroclival region, shorten the surgical time, and minimize the complications. Combined usage of minimally invasive techniques including the keyhole approach and radiosurgey in the treatment of the petroclival meningiomas is suggested.