2026 Proffered Presentations
S252: VISUAL OUTCOMES FOLLOWING SINGLE VS. TWO-STAGED PETROCLIVAL MENINGIOMA RESECTION: PREDICTORS, RECOVERY TRAJECTORIES, AND CLINICAL IMPLICATIONS
Hithardhi Duggireddy, MS; Rommi Kashlan, BS; 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: Visual symptoms are common in patients with petroclival meningiomas (PCMs) due to their proximity to cranial nerves responsible for visual function. A staged resection strategy may be used to minimize risk in anatomically complex cases. However, whether staging improves visual outcomes compared with single-staged surgery remains poorly defined.
Objective: To compare visual outcomes and symptom resolution between single and two-staged PCM resections and to identify predictors of persistent visual deficits at 12 months.
Methods: A retrospective analysis was conducted on 49 patients who underwent PCM resection. 41 patients underwent single-staged resection (83.7%) and 8 underwent two-staged resection (16.3%). Visual symptoms included visual acuity loss, visual field deficits, diplopia, and papilledema, which were measured at baseline, 3, 6, and 12 months. Visual symptom burden was quantified by summing the number of present visual symptoms. Baseline cranial nerve involvement was also recorded. Functional status was recorded with Karnofsky Performance Status (KPS) and modified Rankin Scale (mRS). Group comparisons used Fisher’s exact and nonparametric tests. Multivariable logistic models evaluated predictors of poor visual outcomes and symptom persistence at 12 months. ROC curves assessed model performance. An additional model evaluated factors for predicting selection for staged surgery.
Results: Two-staged resection patients had 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 preoperative mRS (2.6±1.1 vs 1.7±0.7,?p=0.009), and higher frailty scores (1.8±0.7 vs 0.6±0.8,?p=0.001). Age (~50 years, p=0.395) and WHO grade (1.2±0.5 vs 1.1±0.3,?p=0.415) were similar between groups. Baseline visual symptoms were more frequent in staged patients (62.5% vs. 39.0%), with significantly higher rates of visual acuity deficit (50.0% vs 17.5%,?p=0.050) and papilledema (25.0% vs 0.0%,?p=0.002). Rates of visual field loss (12.5% vs 10.0%,?p=0.855) and diplopia (37.5% vs 22.5%,?p=0.386) were comparable. At 12 months, visual acuity deficits persisted more in staged patients (33.3% vs 13.5%, p=0.189), as well as diplopia (50.0% vs 21.6%, p=0.048). Visual field deficits and papilledema resolved in all patients. Changes from baseline to 12 months showed greater resolution in single-staged patients: visual acuity (−4.0% vs −16.7%), visual fields (−10.0% vs −12.5%), and diplopia (−0.9% vs +12.5%). Correlation analyses between complexity and outcomes revealed that higher WHO grade was significantly associated with greater 12-month visual symptom burden (Spearman?ρ=0.459,?p=0.001), and tumor volume revealed a positive trend (ρ=0.289,?p=0.083). Multivariable logistic regression for visual symptom resolution (per-SD effects) identified baseline visual burden as the strongest predictor (OR?6.31), followed by tumor volume (OR?1.25). ROC analysis showed good model performance: AUC?0.794 for poor 12-month visual outcome, AUC?0.744 for visual symptom persistence, and AUC?0.914 for predicting selection of a two-stage approach from baseline factors.
Conclusion: Staged PCM resection was preferentially used for larger, more anatomically complex tumors. While visual symptoms improved over time across both cohorts, visual deficits persisted in the staged group and were primarily driven by baseline burden and tumor complexity. These findings support reserving staged surgery for truly complex cases, while emphasizing in preoperative counseling the elevated risk of persistent visual deficits.
