Petrous Face Meningiomas: Classification, Clinical Syndromes and Surgical Outcomes.

Petrous Face Meningiomas: Classification, Clinical Syndromes and Surgical Outcomes.

World Neurosurg. 2018 Apr 04;:

Authors: Magill ST, Rick JW, Chen WC, Haase DA, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW

Abstract
BACKGROUND: Petrous face meningiomas (PFM) are challenging tumors due to their proximity to the cranial nerves, brainstem and critical vasculature. The objective of this study is to present surgical outcomes and support an anatomic classification for PFM based on clinical presentation.
METHODS: A retrospective chart review was performed, and 51 PFM were identified. Tumors were classified by location along the petrous face into anterior, middle and posterior. Presentation and outcomes were analyzed with logistic regression.
RESULTS: The median follow up was 31.6 months. Tumors were WHO Grade I (n=50), with one WHO Grade II tumor. Location was anterior (22%), middle (14%), posterior (53%), and overlapping (12%). Median tumor diameter was 3.0 cm (0.8-6.2 cm). Anterior location was associated with facial pain/numbness on presentation (p<0.0001), middle location with hearing loss/vestibular dysfunction (p=0.0035), and posterior with hydrocephalus (p=0.0190), headache (p=0.0039) and vertigo (p=0.0265). Extent of resection was gross-total (63%), near-total (14%), and sub-total (25%). The observed radiographic recurrence rate was 15%. Mean progression free survival (PFS) after diagnosis was 9.1 years with 2-, 5-, and 10-year PFS rates of 91.8%, 78.6%, and 62.9%, respectively. The complication rate was 27%. Neither age, location, or approach were associated with complications.
CONCLUSIONS: PFMs present with distinct clinical syndromes based on their location along the petrous face: anterior with trigeminal symptoms, middle with auditory/vestibular symptoms, and posterior with symptoms of mass effect/hydrocephalous. Surgical resection is associated with excellent long-term survival and a low rate of recurrence that can be managed with radiotherapy.

PMID: 29626689 [PubMed - as supplied by publisher]

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