PETROCLIVAL MENINGIOMA

Petroclival Meningioma

Petroclival Meningioma is a complex challenging tumor located deep in the back of the head (posterior fossa). As the tumor progresses it causes compression of the brainstem, engulfing of important arteries, and displacement of cranial nerves. These tumors can cause obstruction of the CSF flow and hydrocephalus

Symptoms

Petroclival Meningioma can present with contralateral motor weakness, swallowing difficulties, voice changes, blurred vision, double vision, headache, facial numbness, facial pain, facial droop, hearing loss, dizziness, balance, and gait difficulties, and hearing loss. Patients with associated hydrocephalus can develop cognitive dysfunction or acute mental status change. Patients with hydrocephalus may need emergency intervention to alleviate intracranial pressure prior to tumor resection.

Treatment

Large symptomatic Petroclival Meningiomas, in general, need surgical intervention. Smaller tumors may be treated only with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs.

Surgical Treatment at the Meningioma Center

At the Meningioma Center, we conceptualized the focal transpetrosal approach which can be used for the removal of complex Petroclival Meningiomas. This approach when associated with the extradural navigation concept allows for direct access to these deep tumors without hazardous exposure to the brain and only minimal direct manipulation or retraction of the brain tissue. At times partial resection of the inner ear maybe needs to facilitate unobstructed visualization of all tumor parts. The approach allows for early identification of involved cranial nerves enhancing function preservation of these important nerves. Moreover, the approach offers maximal potential for complete resection of the tumor. Our team of Ear, Nose, and Throat otologist specialists are directed involved in transpetrosal surgeries and Treatment of these patients.

Small tumor parts at the unfavorable hazardous positions may not be resected to avoid disabling neurological deficits. Postoperatively residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy

Prognosis

Treatment of deep Petroclival Meningiomas through a focused transpetrosal approach enhances the greatest tumor removal, tumor cure, and the potential for recovery from preoperative deficits in patients with these complex tumors. Moreover, patients have the potential for returning to their lifestyle and job occupation. Small tumor parts at the unfavorable hazardous position may not be resected during surgery. The post-operative residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy. Multidisciplinary approach At the Meningioma Center maximizes the potential for cure or control of Petroclival Meningiomas without recurrence and with preservation or recovery of function.