Novel classification of petro-clival meningiomas (PCMs) in intradural anterior trans-petrosal approach

Abstract

Abstract Objective Surgical resection of petro-clival meningiomas (PCMs) is challenging. This study aimed to establish a novel classification of PCMs based on tumor extension during intradural anterior transpetrosal approach (ATPA) and establish optimal surgical strategies for PCMs based on the classification and review the clinical outcomes. Methods Between January 2013 and December 2019, 128 patients of with PCMs underwent surgery by the senior author (Xr.X.). According to tumour extension, we classified the 128 patients into five types (I-V) and introduced key technologies of intradural anterior transpetrosal approach (ATPA) in different types for the first time and achieve a supreme surgical technology. The clinical data, radiological findings, surgical treatment, complications, and outcomes of patients were then retrospectively analysed. Results There are 22 cases (17.2%) belonged to type I, 44 patients (34.4%) of type II, 25 patients (19.5%) of III, 29 patients (22.7%) of IV, 8 patients (6.3%) in type V. Tumours were gross totally removed (GTR, Simpson I and II) in 100 patients (78.1%), sub-totally (STR, Simpson III) in 20 patients (15.6%), partially (PR, Simpson IV) in 8 patients (6.3%). Progression or recurrence rates were 5% (5/100) in GTR, 22.3% (6/20) in STR ,62.5% (5/8, 1 died) in PR. According to Karnofsky Performance Scale and Glasgow Outcome Scale, 108 patients had good recovery (84.4%,108/128) and 115 had independent (89.8%,115/128) at the end of follow-up. Conclusions Totally resection of PCMs is challenging, with the help of our new classification with related key technologies. Increased tumour exposure, greater resection of tumour and nerve function protection can be achieved.