Petroclival Meningiomas: Multimodality Treatment and Outcomes at Long-Term Follow-Up

Objective: To evaluate patients' clinical outcome, survival, and performance status at long-term follow-up after aggressive microsurgical resection of petroclival meningiomas. Methods: Over a 13-year period (1991 to 2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the cases with mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of patients. Thirty patients (20%) were previously operated or irradiated. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and 7 patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (CSF leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation was given to 47 of 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, phone calls, and review of their recent radiological images. Results: At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow up was 101 months (range, 15 to 180 mos). Seven patients (5%) (5 in subtotal and partially resected patients and 2 of the total resection patients) had recurrence, of which 2 underwent repeat resection and 4 were treated with gamma knife. One of the patients died of tumor progression with no response to gamma knife. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years, and the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky performance score was 78 ± 11 preoperatively, 76 ± 11 at 1 year postoperatively, and 84 ± 9 at the latest follow-up. Common disabilities at follow-up included diplopia, loss of hearing, balance problems, and loss of sensation in V1 and V2 cranial nerve distribution. Most patients had developed coping mechanisms. Of the 132 living patients, 108 (72%) were working full-time or were retired, not disadvantaged from doing their work because of the disease or the disabilities at latest follow-up. Twenty-one patients (14%) were able to work part-time or carry out their daily activities of living. Only 3 patients (2%) were severely disabled and required constant help for their daily activities. Conclusion: This series has the largest number of patients with the longest follow-up reported to date in the literature. The excellent quality of life at long-term follow-up for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.