2026 Proffered Presentations
S048: NEUROBEHAVIORAL OUTCOMES AFTER STAGED PETROCLIVAL MENINGIOMA RESECTION: PREDICTORS AND RECOVERY TRAJECTORIES
Rommi Kashlan, BS; Hithardhi Duggireddy, MS; J. Manuel Revuelta-Barbero, MD, PHD; Thomas McCaffery, BS; Karen Salmeron-Moreno, MD; Karthik Papisetty, BA; Gustavo Pradilla, MD; Tomas Garzon-Muvdi, MD, MSc; Emory University
Background: Higher-order deficits, such as cognitive change, personality disturbance, and language dysfunction, can profoundly affect quality of life, impacting a patient’s independence, psychosocial functioning, and long-term rehabilitation. Whether surgical staging for petroclival meningioma (PCM) resection may influence these domains beyond underlying tumor complexity is unclear.
Objective: To examine the prevalence, trajectory, resolution profiles, and predictors of these higher-order symptoms, aiming to elucidate the differences between patients undergoing single and two-staged resections.
Methods: We retrospectively analyzed 49 patients with PCM. 41 patients underwent a single-staged resection (83.7%), while 8 patients underwent a two-staged resection (16.3%). Demographics, tumor volume, WHO grade, and cranial nerve VII involvement were recorded. Language deficits, cognitive dysfunction, personality change, and confusion were assessed at baseline, 3, 6 and 12 months. Symptom burden was the sum of present higher-order symptoms and was tracked over time. Group differences used Mann–Whitney U and Fisher’s exact tests. Regression modeling, feature-importance analysis, and risk stratification (by tumor volume, age, WHO grade, and preoperative burden) were used to identify predictors of outcomes.
Results: Two-stage patients had larger tumors (71.5±58.1 vs 23.0±22.6 cm³, p=0.002) and worse baseline function (mRS 2.6 vs 1.7, p=0.009). Baseline higher-order symptoms were modest overall: cognitive deficits 10.0% (single-stage) versus 12.5% (two-stage); language deficits 5.0% (single-stage) versus 0% (two-stage); personality change 5.0% (single-stage) versus 0% (two-stage); confusion 2.5% (single-stage) versus 25.0% (two-stage). Any higher-order symptom at baseline occurred in 14.6% versus 12.5%. Cranial nerve VII dysfunction was more common in the two-stage cohort (62.5% vs 9.8%, p=0.003). At 12 months, language deficits resolved in all two-stage patients and persisted in 5.4% of single-stage patients. Cognitive deficits rose slightly in single-stage patients (13.5%) but fully resolved in two-stage patients. Personality change persisted in 5.4% of single-stage patients and emerged in 16.7% of two-stage patients. Confusion remained in 12.5% of two-stage patients and was rare after single-stage surgery. Symptom-burden curves showed early improvement in both groups with a late uptick in personality/cognitive complaints, particularly after two-stage resections. Aggregate resolution rates were >90% for language, ~85–100% for cognition, ~80-85% for personality, and ~80-90% for confusion, depending on approach. Outcome distributions indicated 40% of one-stage and 50% of two-stage patients achieved complete resolution, 40% and 35% achieved partial improvement, and ~15-20% had no change or worsened. Feature-importance modeling identified tumor volume (0.32) and preoperative higher-order symptom burden as the strongest predictors of persistent deficits. After adjustment for complexity, surgical staging was not independently predictive of outcome. Risk stratification showed that low-risk patients (small tumors, ≤1 symptom) achieved 40-55% complete resolution, whereas high-risk patients (large tumors, multiple symptoms) had the greatest likelihood of persistent personality change or confusion.
Conclusion: Higher-order symptoms improved across both cohorts, with symptom persistence being primarily driven by larger tumor volume and greater preoperative burden. Staged resection was disproportionately associated with confusion; however, staging was not independently predictive of outcomes after adjustment. These findings support risk-stratified counseling, routine preoperative cognitive/psychosocial assessment, and targeted rehabilitation, with selective staging reserved for anatomically complex cases.
