Surgical treatment of patients with giant petroclival meningiomas

Аннотация

Background. Surgical treatment of petroclival meningiomas (PCM), especially of giant PCM, remains one of the most difficult problems in neurosurgery and is associated with high risks of postoperative morbidity and mortality.

Aim. to determinate frequency and reversibility of post-operative neurological deficit after giant PCMs resection as well as identify risk factors of this surgery and the resection quality of these tumors.

Materials and methods. The results of surgical treatment of 18 patients underwent 22 operations to resect giant PCMs were retrospectively studied. The neurological status and Karnofsky Performance Scale (KPS) of patients were assessed before surgery, immediately after and 6 months later, as well as neuroimaging characteristics of tumors before and after surgery were studied. We analyzed the influence of various factors on neurological outcomes and the resection quality.

Results. The average PCM volume before surgery was 46.3 ± 25.4 cm3, the average resection volume was 81 ± 16.8 %. The incidence of neurological deficit in the early postoperative period was 63.6 %, mortality was 0 %. The most common complication was injury of cranial nerves (63.6 %). The scores according to Karnofsky Performance Scale (KPS) before surgery (median 80 %) improved 6 months after surgery (median 90 %). The PCMIS after 6 months was on average equal to the preoperative level (8.1 ± 6.3 and 7.5 ± 5.3, respectively). Low Karnofsky Performance Scale status before surgery (<70 %) did not affect the occurrence of postoperative deficit (p = 0.465)

Conclusion. Surgery of giant PCMs is a difficult problem. Subcompensated patients with these tumors are often rejected in surgical treatment, however, our results demonstrate that this surgery leads in most cases to an improvement in the patients’ neurological condition in 6 months after surgery, while using the surgical treatment principles described by us.