2025 Proffered Presentations
S212: COMPARISON OF TWO SURGICAL APPROACHES AND OUTCOMES FOR PETROCLIVAL MENINGIOMAS: A SINGLE-SURGEON SERIES OF CONSECUTIVE CASES
Salomon Cohen Cohen, MD; Rahul Kumar, MD, PhD; Michael J Link, MD; Mayo Clinic, Rochester MN
Background and Objectives: Petroclival meningiomas (PCM), though rare, present significant challenges in skull base surgery. This study compares outcomes between two common surgical approaches employed by a senior surgeon for PCM treatment.
Methods: This retrospective cohort study included consecutive PCM (meningiomas with an epicenter on the upper and middle clivus and medial to the trigeminal nerve) patients treated via either retrolabyrinthine posterior petrosectomy or retrosigmoid approach between August 2003 and December 2022. Patients with less than three months of follow-up or prior treatments were excluded. Baseline characteristics, procedural complications, operative time, extent of resection, and clinical outcomes were compared between the two groups.
Results: A total of 47 patients (median age: 58 years; median follow-up: 4.5 years) were included with 26 (55.3%) undergoing posterior petrosectomy and 21 (44.6%) undergoing retrosigmoid approach. Between retrosigmoid and posterior petrosectomy groups, no significant differences in tumor size (2.9 cm vs. 2.8 cm, p = 0.990) or preoperative volume (7.2 cm³ vs. 9.5 cm³, p = 0.669) were noted. Common presenting symptoms included facial numbness (36%), trigeminal neuralgia (19%), and diplopia (11%). Gross total resection was achieved in 11 patients (23%) with no significant difference by approach (p = 0.181). Postoperative volume reduction did not differ significantly between groups (-86% vs. -82% volume change, p = 0.525). Median operative time (5.9 hours vs. 9.2 hours, p<0.001) and hospital stay (5 vs. 7 days, p = 0.010) were significantly shorter in the retrosigmoid group. Complications occurred in 62% of patients, with insignificant difference between groups (47% vs. 73%, p = 0.138). Resolution or improvement of facial pain was noted in 78% of patients with neuralgia. Twenty-eight patients (60%) received postoperative radiation. Median progression-free survival was 14.2 years and comparable between groups (p = 0.083). Twenty-eight patients (60%) underwent postoperative radiation treatment, including 13 patients (46%) for tumor progression after STR, 1 patient for tumor recurrence after GTR (4%) and 14 patients (50%) for adjuvant management of residual tumors. Two patients who received adjuvant radiation developed a second progression. There were no operative deaths.
Conclusions: In this series, the retrosigmoid approach demonstrated shorter operative times and hospital stays compared to posterior petrosectomy without compromising the extent of resection or progression-free survival rates.