Challenges In The Management Of Petroclival Meningioma: Case Report And Review Of Literature

Abstract

Petroclival meningiomas arise along the upper 2/3rds of the clivus in the region of the petroclival fissure, medial to the internal acoustic meatus and posterior to the gasserian ganglion. They represent about 2% of all intracranial meningiomas but are regarded as one of the most formidable challenges in neurosurgery. This is due to their intimate relations to the basilar artery, brainstem and lower cranial nerves in the upper posterior fossa region. They predominantly affect middle-aged women and have an insidious onset with patients developing headaches and gait abnormalities. Cranial nerve palsies usually prompt initial hospital visits with some patients also developing obstructive hydrocephalus. They usually present as large tumors and associated invasion of the parasellar region, carvenous sinus, tentorium or foramen magnum is not uncommon. Early surgical experience had dismal outcomes with mortality rates exceeding 50%. Subsequent refinement in approaches and the microsurgical era have greatly improved outcomes with increasing rates of total resection and long-term survival. Herein, we present the case of a middle-aged woman recently managed in our neurosurgical unit. Her clinical presentation, surgical management and post-operative course is detailed with the inherent challenges faced highlighted. A review of the current literature is further provided, emphasizing the complex nature of these lesions and the nuanced neurosurgical approaches required to achieve maximal resection with preservation and/or improvement of neurological function.