Treatment Decision-making for Petrous Apex and Petroclival Meningiomas

Abstract

  Treating petrous apex and petroclival meningiomas requires advanced surgical technique and extensive experience. In particular, in cases with strong adhesions to surrounding structures, the conflict between “functional preservation” and “resection rate” becomes a problem. However, because meningiomas in these areas are also pathologically benign, the ideal treatment is to perform maximum resection without any complications, suppress the recurrence rate, and maintain the patient's quality of life (QOL) over a long period of time. Not only improvements in surgical techniques, but also the overall ability to judge specific aspects of treatment, including follow-up, multi-staged surgeries, and radiation therapy, and a well-balanced treatment approach are demanded. In addition, the latest advancements in diagnostic imaging techniques have been remarkable, and not only the spatial relationships with surrounding structures, the degree of adhesion, the tumor blood flow and the stiffness, but also the growth and recurrence rates of the tumor itself are becoming increasingly predictable.