2026 Proffered Presentations
S145: STAGED RESECTION IN PETROCLIVAL MENINGIOMA: TRADEOFFS IN MORBIDITY, RECOVERY, AND FUNCTIONAL OUTCOMES
J. Manuel Revuelta-Barbero, MD, PHD; Rommi Kashlan, BS; Hithardhi Duggireddy, MS; Thomas McCaffery, BS; Karen Salmeron-Moreno, MD; Karthik Papisetty, BA; Gustavo Pradilla, MD; Tomas Garzon-Muvdi, MD, MSc; Emory University
Background: Petroclival meningiomas (PCMs) are technically demanding skull base tumors due to their proximity to critical neurovascular structures and cranial nerves. Contemporary management favors tailored approaches to achieve maximal safe resection. Surgeons may adopt a staged approach for larger or more complex tumors, yet comparative data on perioperative morbidity and functional outcomes between single and two-staged resections remain limited.
Objective: To compare perioperative morbidity, postoperative clinical outcomes, and longitudinal symptom trajectories between single and two-staged PCM resections, and to evaluate determinants of poor postoperative outcomes.
Methods: A retrospective analysis was conducted on 49 patients undergoing PCM resection. 41 patients underwent a single-staged resection (83.7%), while 8 patients underwent a two-staged resection (16.3%). Baseline variables included age, tumor volume, Modified Frailty Index (mFI-5), and preoperative modified Rankin Scale (mRS). Perioperative outcomes included ICU stay duration, tracheostomy/gastrostomy (trach/PEG) placement, estimated blood loss, complications, and unplanned reinterventions. Extent of resection was categorized as gross total, near total, or subtotal. Functional outcomes were assessed using discharge mRS. Symptom burden and trajectory were evaluated longitudinally over 12 months through severity scoring and binary symptom count. ROC analysis assessed the predictive value of staging, frailty, tumor volume, and age for ICU admission, trach/PEG placement, and poor functional outcome (mRS≥4). Effect sizes were calculated using Cohen’s d. Group comparisons used Fisher’s exact, t-tests, or Mann–Whitney U tests, as appropriate.
Results: Baseline demographics were similar between resection groups with respect to age, sex, and WHO grade, but two-staged resection patients presented with significantly larger tumors (71.5±58.1 vs 23.0±22.6 cm³; p=0.002), lower preoperative KPS (71.2±11.3 vs 86.9±7.3;p<0.001), higher frailty scores (1.88 vs 0.88, p<0.001), and higher preoperative symptom burden (p=0.024). Perioperative morbidity was greater in the staged cohort, with longer ICU stays (26.9±7.2 vs 5.1±5.7 days; p<0.001), universal trach/PEG placement (100.0% vs 22.9%, p<0.001), and greater estimated blood loss (487.5±83.5 vs 242.9±97.6 mL; p=0.002). Reintervention rates were also higher (50.0% vs 13.5%; p=0.039). Despite greater complexity, extent of resection was comparable between groups (GTR: 37.5% vs 43.9%, NTR: 37.5% vs 22.0%, STR: 25.0% vs 34.1%; p=0.639). Functional outcomes were worse in staged patients, with significantly higher discharge mRS scores (4.8±0.5 vs 2.9±1.0, p<0.001), however both groups improved over time, with no significant difference in symptom burden at 12 months (4.0±2.5 vs 2.4±2.2, p=0.170). ROC analysis identified two-stage resection as the strongest predictor of poor short-term functional outcomes (mRS≥4, AUC=0.92), followed by frailty (AUC=0.86), tumor volume (AUC=0.82), and age (AUC=0.77). Staging also strongly predicted ICU admission (AUC=0.91) and trach/PEG placement (AUC=0.98). Effect sizes were large across multiple outcomes, including ICU length of stay (d=2.0), blood loss (d=1.6), and discharge mRS (d=2.1).
Conclusion: Staged resection was reserved for patients with greater tumor burden and clinical complexity, resulting in higher perioperative morbidity and delayed short-term recovery. Despite these challenges, extent of resection was comparable, and symptom trajectories improved over time. These findings highlight the need to balance operative risk with long-term functional goals in staged resections, underscoring the importance of patient selection, counseling, and perioperative optimization in managing complex PCMs.
