2026 Proffered Presentations
S144: VESTIBULOCOCHLEAR OUTCOMES FOLLOWING SINGLE VS. TWO-STAGE PETROCLIVAL MENINGIOMA RESECTION
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: Petroclival meningiomas pose formidable surgical challenges due to their proximity to critical neurovascular structures and frequent involvement of the internal auditory canal. Vestibulocochlear symptoms such as hearing loss, tinnitus, vertigo, and imbalance are common at presentation and can worsen after resection. Surgical strategy remains debated: one-stage resection provides definitive treatment but requires prolonged manipulation, while staged resection may be better suited for complex case\\\s, but subjects patients to repeat procedures. This study evaluates vestibulocochlear outcomes in one-stage versus two-stage resections.
Objective: To compare vestibulocochlear outcomes between one-stage and two-stage petroclival meningioma resections and to identify predictors of persistent deficits.
Methods: A retrospective analysis was conducted on 49 patients undergoing resection of petroclival meningiomas between 2010 and 2024. 41 patients underwent single-staged resection (83.7%) and 8 underwent two-staged resection (16.3%). Baseline demographics, tumor volume, WHO grade, functional status (mRS), and CN VII–VIII dysfunction were recorded. Vestibulocochlear symptoms (hearing loss, tinnitus, vertigo, nausea/vomiting, gait imbalance) were assessed at baseline, 3, 6 and 12 months. Outcomes were assessed at 12-month follow-up, with symptom prevalence, cranial nerve dysfunction, and functional recovery compared between groups with Mann-Whitney U and Fisher’s exact tests. Correlation analyses assessed tumor complexity and outcome, and multivariable logistic regression identified predictors of persistent vestibulocochlear dysfunction.
Results: Two-stage patients had larger tumors (71.5±58.1 vs 23.0±22.6 cm³; p=0.002) and worse preoperative mRS (2.6±1.1 vs 1.7±0.7; p=0.009). Preoperative vestibulocochlear symptom prevalence was comparable between groups: hearing loss (40% vs 37.5%), vertigo (41% vs 37.5%), and gait deficits (45% vs 62.5%). However, two-stage patients had higher rates of cranial nerve VII dysfunction (62.5% vs 9.8%, p=0.003) and cranial nerve VIII dysfunction (75% vs 22%, p=0.007). At 12 months, both groups demonstrated substantial improvement. Nausea and vomiting resolved completely. Tinnitus prevalence fell to 2.7% in one-stage patients and was absent in two-stage patients. Vertigo persisted in 8.1% of one-stage patients but resolved in all two-stage patients. Hearing loss persisted in 32.4% of single-stage versus 50% of two-stage patients (p=0.122). Gait deficits remained significantly more prevalent in the two-stage group (66.7% vs 21.6%, p=0.004). Complexity analyses demonstrated that tumor volume and WHO grade did not correlate significantly with either preoperative or 12-month vestibulocochlear burden (p>0.2). In contrast, regression modeling identified preoperative vestibulocochlear symptom burden as the strongest predictor of poor long-term outcome (OR=5.49). Age and tumor volume trended toward worse outcomes (OR=0.68 and 0.97 respectively), while single-stage resection independently improved odds of symptom resolution (OR=1.71).
Conclusion: Single-stage resection was associated with superior vestibulocochlear recovery compared with two-stage surgery, despite similar baseline symptom prevalence. Patients undergoing staged resections presented with larger, more complex tumors, and higher rates of preoperative cranial nerve dysfunction, contributing to worse postoperative outcomes. Resolution of nausea, vertigo, and tinnitus was common across both strategies, while hearing loss and gait impairment persisted more frequently after two-stage procedures. Preoperative symptom burden emerged as the most powerful predictor of outcomes. Surgical planning should incorporate baseline vestibulocochlear deficits when selecting operative strategy. For appropriately selected patients, one-stage resection offers the greatest likelihood of functional preservation.
