Posterior cranial fossa meningiomas

Abstract

This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.2%). Headache was the most common symptom. Retrosigmoid approach was the commonest surgical procedure (23.4%). The incidence of cranial nerve related complications was 28%. Postoperatively facial nerve weakness was observed in 11%. The incidence of cerebrospinal fluid leak was 4.6%. Gross total resection was achieved in 37 patients (58%). Sixteen patients (25%) with residual tumors underwent Gamma knife radiosurgery. Recurrence or tumor progression was observed in 12 patients (18.7%). Operative mortality was 3.1%. At their last follow-up, 93% of the cases achieved Glasgow Outcome Scale scores 4 or 5. Total excision is the ideal goal which can be achieved with meningiomas located in certain location, such as lateral convexity, but for other posterior fossa meningiomas the close proximity of critical structures is a major obstacle in achieving this goal. In practicality, a balance between good functional outcome and extent of resection is important for posterior cranial fossa meningiomas in proximity to critical structures.

Keywords: meningiomas; posterior fossa; skull base.

Figure 1

Axial T2-weighted magnetic resonance images (A, B) showing a large left-sided petroclival meningioma. Axial postcontrast magnetic resonance images (C, D) showing gross total excision.

Figure 2

Axial (A) and sagittal (B) T1-weighted postcontrast magnetic resonance images showing a large foramen magnum meningioma. Axial postcontrast magnetic resonance (C) and sagittal postcontrast magnetic resonance (D) images showing gross total excision.

Figure 3

Axial (A) and coronal (B) T1-weighted postcontrast magnetic resonance images showing a large central tentorial meningioma. Axial postcontrast magnetic resonance (C) and coronal postcontrast magnetic resonance (D) images showing gross total excision.

Figure 4

Axial postcontrast magnetic resonance images (A, B) showing a large left-sided lateral petrous meningioma. Axial postcontrast magnetic resonance images (C, D) showing gross total excision.

Figure 5

Axial postcontrast magnetic resonance image (A) showing a large cerebellar convexity meningioma. Axial postcontrast computed tomography scan image (D) showing gross total excision.