2025 Poster Presentations
P138: SURGICAL OUTCOMES OF THE PETROCLIVAL MENINGIOMAS RELATED TO TUMOR TYPE: CLASSIC TUMOR CLASSIFICATION AND RECENT UPDATED SURGICAL APPROACHES
Dong-Won Shin1; Chang-Ki Hong2; 1Gachon University Gil Medical Center; 2Asan Medical Center
Purpose: To evaluate surgical outcomes of petroclival meningiomas based on tumor types and approaches, including the endoscopic transorbital approach (eTOA).
Methods: This retrospective study reviewed 47 patients who underwent surgery for petroclival meningiomas from March 2021 to December 2022. Tumor types were classified into cavernous, upper clival, petrous apex, and tentorial. Surgical approaches included anterior petrosal, combined petrosal, retrosigmoid, and eTOA. Outcomes were analyzed based on tumor size, extent of resection, and cranial nerve preservation.
Results: Patients' median follow-up was 13.6 months. The mean tumor size was 3.2 cm. WHO grade 1 meningioma was found in 37 patients, and grade 2 in 10. Preoperative symptoms included facial pain (46.8%), headache (19.1%), and hearing loss (19.1%). The most common surgical approach was anterior petrosal approach (63.8%). Gross total resection (GTR) was achieved more frequently in smaller tumors (mean size 3.1 cm, p = 0.038) and those with high T2WI signal intensity (p = 0.013). Postoperative cranial nerve palsies occurred in 44.7% of patients, with the abducent nerve being the most commonly affected. Complications included cerebrospinal fluid leakage (8.7%) and temporal lobe injury (10.6%).
Conclusion: Surgical outcomes of petroclival meningiomas are influenced by tumor type and approach. GTR is associated with smaller tumor size and specific imaging characteristics. While the eTOA shows promise, it cannot fully replace open craniotomy. Comprehensive anatomical knowledge and multidisciplinary collaboration are essential for optimizing surgical outcomes and minimizing morbidity.