The results of microsurgery of large and giant petrous bone meningiomas depending on the location of the tumor matrix

INTRODUCTION. The posterior petrous bone meningiomas are one of the most difficult tumors for microsurgical removal. Despite the modern possibilities of neurosurgery, the mortality and disability rates of these patients continue to be high.

AIM. To analyze results of microsurgery of posterior petrous bone meningiomas depending on the location of the tumor matrix.

MATERIALS AND METHODS. The study assessed the results of microsurgical treatment of 59 patients with large and giant posterior petrous bone meningiomas. All patients underwent microsurgical removal of the tumor by retrosigmoid approach. The Karnofsky Performance Scale Index at admission and discharge, the radicality of surgery, the presence of complications, the severity of neurological disorders and the outcome on the Glazgo Outcome Scale Extended were assessed.

RESULTS. In 30.5 % of patients, meningiomas had petroclival localization, in 10.2 % of cases the tumor matrix was located in the area of the jugular foramen, in 8.5 % of patients the matrix was expanded and occupied the entire surface of the petrous bone and in 50.8 % of cases the tumor arose in the area of the posterior surface of the petrous bone. In 76.3 % of cases, the tumor was removed radically, in 15.2 % – subtotally and in 8.5 % – partially. The median functional status at the time of discharge was the highest in the group of patients with meningiomas of the posterior face of the petrous bone (p=0.006). Ischemic complications were more common in patients with an extended matrix (p=0.002). The best results of facial nerve function were achieved in the group of patients with meningiomas of the posterior face of the petrous bone (p<0.001). The largest number of patients with postoperative prosoparesis was observed in the groups of jugular meningiomas (p=0.016) and meningiomas with an extended matrix (p=0.032).

CONCLUSION. The results of surgical treatment depend on the size and the localization of the tumor matrix. The greatest radicality and the best functional outcomes can be achieved in the group of patients with meningiomas of the posterior face of the petrous bone. The most common postoperative neurological disorders and low functional status were observed in patients with an extended tumor matrix over the entire surface of the petrous bone.

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