BACKGROUND: The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS: A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS: The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION: This article represents the consensually derived opinion of the task force with respect to the management of PCMs.

Department of Neurosurgery 1st Medical Faculty Military University Hospital and Charles University Prague Czech Republic

Department of Neurosurgery and Gamma Knife Center University Hospital of Lausanne and Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland

Department of Neurosurgery Barts Health NHS Trust St Bartholomew's and The Royal London Hospital London UK

Department of Neurosurgery Brigham and Women's Hospital Harvard Medical School Boston MA USA

Department of Neurosurgery Carolina Neuroscience Institute Raleigh NC USA

Department of Neurosurgery Complejo Hospitalario de Navarra Pamplona Spain

Department of Neurosurgery Eberhard Karls University of Tübingen Tübingen Germany

Department of Neurosurgery Erasme Hospital Brussels Belgium

Department of Neurosurgery Hopital Neurologique Pierre Wertheimer Lyon France

Department of Neurosurgery Johann Wolfgang Goethe University Frankfurt am Main Germany

Department of Neurosurgery Lariboisière Hospital Université Paris Diderot Paris France

Department of Neurosurgery Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany

Department of Neurosurgery Osaka City University Graduate School of Medicine Osaka Japan

Department of Neurosurgery University Hospital of Geneva Geneva Switzerland

Department of Neurosurgery University Hospital of Naples Federico 2 Napoli NA Italy

Department of Neurosurgery University Medicine Greifswald Greifswald Germany

Zobrazit více v PubMed

Abdel Aziz KM, Sanan A, Van Loveren HR, Tew J, Keller JT, Pensak ML, Diaz Day J (2000) Petroclival meningiomas: Predictive parameters for transpetrosal approaches. Neurosurgery. https://doi.org/10.1097/00006123-200007000-00030

Adachi K, Hasegawa M, Tateyama S, Kawazoe Y, Hirose Y (2018) Surgical Strategy for and Anatomic Locations of Petroapex and Petroclival Meningiomas Based on Evaluation of the Feeding Artery. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.05.052

Adachi K, Hayakawa M, Ishihara K, Ganaha T, Nagahisa S, Hasegawa M, Hirose Y (2016) Study of Changing Intracranial Venous Drainage Patterns in Petroclival Meningioma. World Neurosurg 92:339–348 PubMed

Adeberg S, Harrabi SB, Verma V, Bernhardt D, Grau N, Debus J, Rieken S (2017) Treatment of meningioma and glioma with protons and carbon ions. Radiat Oncol 12(1):193 PubMed PMC

Agarwal V, McCutcheon BA, Hughes JD, Carlson ML, Glasgow AE, Habermann EB, Nguyen QB, Link MJ, Van Gompel JJ (2017) Trends in Management of Intracranial Meningiomas: Analysis of 49,921 Cases from Modern Cohort. World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.06.127

Al-Mefty O, Ayoubi S, Smith RR (1991) The petrosal approach: indications, technique, and results. Acta neurochirurgica Supplementum. https://doi.org/10.1007/978-3-7091-9183-5_27

Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O (2014) True petroclival meningiomas: results of surgical management. J Neurosurg 120(1):40–51 PubMed

Altieri R, Sameshima T, Pacca P, Crobeddu E, Garbossa D, Ducati A, Zenga F (2017) Detailed anatomy knowledge: first step to approach petroclival meningiomas through the petrous apex. Anatomy lab experience and surgical series. Neurosurg Rev 40(2):231–239 PubMed

Arnaout O, Al-Mefty O (2017) Combined petrosal approach for petroclival meningioma. Neurosurg Focus 43(VideoSuppl2):V6 PubMed

Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, Spetzler RF (2008) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 62(6 Suppl 3):1182–1191 PubMed

Beer-Furlan A, Abi-Hachem R, Jamshidi AO, Carrau RL, Prevedello DM (2016) Endoscopic trans-sphenoidal surgery for petroclival and clival meningiomas. J Neurosurg Sci

Beer-Furlan A, Vellutini EAS, Balsalobre L, Stamm AC (2015) Endoscopic Endonasal Approach to Ventral Posterior Fossa Meningiomas: From Case Selection to Surgical Management. Neurosurg Clin N Am 26(3):413–426 PubMed

Beer-Furlan A, Vellutini EA, Gomes MQT, Cardoso AC, Prevedello LM, Todeschini AB, Prevedello DM (2019) Approach Selection and Surgical Planning in Posterior Cranial Fossa Meningiomas: How i Do It. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0038-1675589

Beniwal M, Bhat DI, Rao N, Bhagavatula ID, Somanna S (2015) Surgical management of petroclival meningiomas: Factors affecting early post-operative outcome. Br J Neurosurg. https://doi.org/10.3109/02688697.2015.1019422

Benz LS, Wrensch MR, Schildkraut JM, Bondy ML, Warren JL, Wiemels JL, Claus EB (2018) Quality of life after surgery for intracranial meningioma. Cancer 124(1):161–166 PubMed

Bernard F, Troude L, Isnard S, Lemée J-M, Terrier LM, François P, Velut S, Gay E, Fournier H-D, Roche P-H (2019) Long term surgical results of 154 petroclival meningiomas: A retrospective multicenter study. Neurochirurgie 65(2–3):55–62 PubMed

Bernat AL, Oyama K, Hamdi S, Mandonnet E, Vexiau D, Pocard M, George B, Froelich S (2015) Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients. Acta Neurochir (Wien) 157(10):1741–1746

Bindal R, Goodman JM, Kawasaki A, Purvin V, Kuzma B (2003) The natural history of untreated skull base meningiomas. Surg Neurol. https://doi.org/10.1016/S0090-3019(02)00995-3

Bir SC, Maiti TK, Bollam P, Nanda A (2016) Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma. J Neurol Surg B Skull Base 77(1):47–53 PubMed

Borghei-Razavi H, Tomio R, Fereshtehnejad SM, Shibao S, Schick U, Toda M, Yoshida K, Kawase T (2015) Pathological Location of Cranial Nerves in Petroclival Lesions: How to Avoid Their Injury during Anterior Petrosal Approach. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0035-1555137

Borghei-Razavi H, Truong HQ, Fernandes Cabral DT, Sun X, Celtikci E, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC (2019) Endoscopic endonasal petrosectomy: Anatomical investigation, limitations, and surgical relevance. Oper Neurosurg. https://doi.org/10.1093/ons/opy195

Bossi Todeschini A, Montaser AS, Hardesty DA, Carrau RL, Prevedello DM (2018) The limits of the endoscopic endonasal transclival approach for posterior fossa tumors. J Neurosurg Sci 62(3):322–331 PubMed

Bricolo AP, Turazzi S, Talacchi A, Cristofori L (1992) Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31(5):813–828 discussion 828 PubMed

Campero Á, Tovar L, Ajler P (2019) Resection of a Dumbbell Skull Base Meningioma by a Combined Two-Staged Retrosigmoid and Transzygomatic Transcavernous Approach. Journal of Neurological Surgery

Carvalho GA, Matthies C, Tatagiba M, Eghbal R, Samii M (2000) Impact of computed tomographic and magnetic resonance imaging findings on surgical outcome in petroclival meningiomas. Neurosurgery. https://doi.org/10.1097/00006123-200012000-00005

Castellano F, Ruggiero G (1953) Meningiomas of the posterior fossa. Acta radiologica. Supplementum

Chanda A, Nanda A (2002) Partial labyrinthectomy petrous apicectomy approach to the petroclival region: An anatomic and technical study. Neurosurgery

Chen LF, Yu XG, Bu B, Xu BN, Zhou DB (2011) The retrosigmoid approach to petroclival meningioma surgery. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2011.03.027

Couldwell WT (2008) Comment to Surgical removal of small petroclival meningiomas. Acta Neurochirurgica. https://doi.org/10.1007/s00701-007-1403-y

Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84(1):20–28 PubMed

Desgeorges M, Sterkers O (1994) Anatomo-radiological classification of meningioma of the posterior skull base. Neurochirurgie 40(5):273–295 PubMed

Di Carlo DT, Capo G, Fava A, Cagnazzo F, Margil-Sànchez M, Champagne P-O, Voormolen EHJ, Morganti R, Froelich S, Perrini P (2020) Petroclival meningiomas: the risk of post-operative cranial nerve deficits among different surgical approaches-a systematic review and meta-analysis. Acta Neurochir (Wien) 162(9):2135–2143

DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin P, Guo C, Chin LS (2004) Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2004.05.073

Diluna ML, Bulsara KR (2010) Surgery for petroclival meningiomas: A comprehensive review of outcomes in the skull base surgery era. Skull Base. https://doi.org/10.1055/s-0030-1253581

Dogan I, Ocak PE, Pyle GM, Başkaya MK (2017) Resection of middle petroclival meningioma via combined anterior transpetrosal and retrosigmoid approaches at two separate stages: 3D operative video. Neurosurg Focus 43(VideoSuppl2):V12 PubMed

Fatima N, Meola A, Pollom E, Chaudhary N, Soltys S, Chang SD (2019) Stereotactic Radiosurgery in Large Intracranial Meningiomas: A Systematic Review. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.06.064

Flannery TJ, Kano H, Lunsford LD, Sirin S, Tormenti M, Niranjan A, Flickinger JC, Kondziolka D (2010) Long-term control of petroclival meningiomas through radiosurgery: Clinical article. J Neurosurg. https://doi.org/10.3171/2009.8.JNS09695

Freeman JL, Sampath R, Quattlebaum SC, Casey MA, Folzenlogen ZA, Ramakrishnan VR, Youssef AS (2018) Expanding the endoscopic transpterygoid corridor to the petroclival region: Anatomical study and volumetric comparative analysis. J Neurosurg. https://doi.org/10.3171/2017.1.JNS161788

Fukushima PRT, Diaz Day J, Hirahara K (1996) Extradural total petrous apex resection with trigeminal translocation for improved exposure of the posterior cavernous sinus and petroclival region. Skull Base Surg 6(2):95–103 PubMed PMC

Gerganov VM, Giordano M, Elolf E, Osamah A, Amir S, Madjid S (2014) Operative management of patients with radiosurgery-related trigeminal neuralgia: Analysis of the surgical morbidity and pain outcome. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2014.04.016

Giammattei L, Borsotti F, Daniel RT (2019) Extreme lateral supracerebellar infratentorial approach: how I do it. Acta Neurochirurgica. https://doi.org/10.1007/s00701-019-03886-5

Giammattei L, Starnoni D, Levivier M, Messerer M, Daniel RT (2019) Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.05.253

Goel A (1999) Extended lateral subtemporal approach for petroclival meningiomas: Report of experience with 24 cases. Br J Neurosurg. https://doi.org/10.1080/02688699943673

Goldbrunner R, Minniti G, Preusser M (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. https://doi.org/10.1016/S1470-2045(16)30321-7

Gonzalez LF, Crawford NR, Horgan MA et al (2002) Working area and angle of attack in three cranial base approaches: Pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery 50(3):550–557 PubMed

Gosal J, Behari S, Joseph J, Jaiswal A, Sardhara J, Iqbal M, Mehrotra A, Srivastava A (2018) Surgical excision of large-to-giant petroclival meningiomas focusing on the middle fossa approaches: The lessons learnt. Neurol India. https://doi.org/10.4103/0028-3886.241354

Gross BA, Tavanaiepour D, Du R, Al-Mefty O, Dunn IF (2012) Evolution of the posterior petrosal approach. Neurosurg Focus 33(2):E7 PubMed

Grossi PM, Nonaka Y, Watanabe K, Fukushima T (2012) The history of the combined supra- and infratentorial approach to the petroclival region. Neurosurg Focus:33

Hakuba A, Nishimura S, Jang BJ (1988) A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 30(2):108–116 PubMed

Han JH, Suh MJ, Kim JW, Cho HS, Moon IS (2017) Facial reanimation using hypoglossal-facial nerve anastomosis after schwannoma removal. Acta Oto-Laryngologica. https://doi.org/10.1080/00016489.2016.1212398

Harland TA, Freeman JL, Davern M, McCracken DJ, Celano EC, Lillehei K, Olson JJ, Ormond DR (2018) Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma. J Neuro-Oncol. https://doi.org/10.1007/s11060-017-2656-9

Hashimoto N, Rabo CS, Okita Y (2012) Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies: Clinical article. J Neurosurg. https://doi.org/10.3171/2011.11.JNS11999

Hirohata M, Abe T, Fujimura N, Takeuchi Y, Shigemori M (2006) Preoperative embolization of brain tumor with pial artery or dural branch of internal carotid artery as feeding artery. Interv Neuroradiol. https://doi.org/10.1177/15910199060120s145

Horgan MA, Anderson GJ, Kellogg JX, Schwartz MS, Spektor S, McMenomey SO, Delashaw JB (2000) Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg 93(1):108–112 PubMed

Hunter JB, Weaver KD, Thompson RC, Wanna GB (2015) Petroclival Meningiomas. Otolaryngol Clin N Am. https://doi.org/10.1016/j.otc.2015.02.007

Ichimura S, Kawase T, Onozuka S, Yoshida K, Ohira T (2008) Four subtypes of petroclival meningiomas: Differences in symptoms and operative findings using the anterior transpetrosal approach. Acta Neurochirurgica. https://doi.org/10.1007/s00701-008-1586-x

Ilyas A, Przybylowski C, Chen CJ, Ding D, Foreman PM, Buell TJ, Taylor DG, Kalani MY, Park MS (2019) Preoperative embolization of skull base meningiomas: A systematic review. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2018.06.022

Islim AI, Mohan M, Moon RDC, Srikandarajah N, Mills SJ, Brodbelt AR, Jenkinson MD (2019) Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes. J Neuro-Oncol. https://doi.org/10.1007/s11060-019-03104-3

Isolan GR, Wayhs SY, Lepski GA, Dini LI, Lavinsky J (2018) Petroclival Meningiomas: Factors Determining the Choice of Approach. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0037-1608654

Iwai Y, Yamanaka K, Shimohonji W, Ishibashi K (2019) Staged Gamma Knife Radiosurgery for Large Skull Base Meningiomas. Cureus 11(10):e6001 PubMed PMC

Jacquesson T, Berhouma M, Jouanneau E (2014) Comparison between the Anterior Petrosectomy and the Expanded Endoscopic Endonasal Approach Interest in Skull Base Tumors Surgical Management. J Neurol Surg Part B: Skull Base. https://doi.org/10.1055/s-0034-1383984

Jacquesson T, Cotton F, Attyé A, Zaouche S, Tringali S, Bosc J, Robinson P, Jouanneau E, Frindel C (2019) Probabilistic Tractography to Predict the Position of Cranial Nerves Displaced by Skull Base Tumors: Value for Surgical Strategy Through a Case Series of 62 Patients. Clin Neurosurg 85(1):E125–E136

Jo KI, Kim B, Cha MJ, Choi J-H, Jeon P, Kim KH (2016) Safety and efficacy of medium-sized particle embolisation for skull-base meningioma. Clinical Radiology 71(4):335–340 PubMed

Jung HW, Yoo H, Paek SH, Choi KS (2000) Long-term outcome and growth rate of subtotally resected petroclival meningiomas: Experience with 38 cases. Neurosurgery 46(3):567–575 PubMed

Kano H, Awan NR, Flannery TJ, Iyer A, Flickinger JC, Lunsford LD, Kondziolka D (2011) Stereotactic radiosurgery for patients with trigeminal neuralgia associated with petroclival meningiomas. Stereotact Funct Neurosurg. https://doi.org/10.1159/000321187

Kawase T, Shiobara R, Ohira T, Toya S (1996) Developmental patterns and characteristic symptoms of petroclival meningiomas. Neurol Med-Chir. https://doi.org/10.2176/nmc.36.1

Kawase T, Shiobara R, Toya S (1994) Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas selective pyramid resection and radicality. Acta Neurochir. https://doi.org/10.1007/BF01406489

Kawase T, Toya S, Shiobara R, Mine T (1985) Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. https://doi.org/10.3171/jns.1985.63.6.0857

Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH (2017) Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: An update. Pain Res Manag. https://doi.org/10.1155/2017/7438326

Kim JW, Jung HW, Kim YH, Park CK, Chung HT, Paek SH, Kim DG, Lee SH (2020) Petroclival meningiomas: Long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution. J Neurosurg. https://doi.org/10.3171/2019.2.JNS182604

Klironomos G, Chiluwal A, Dehdashti AR (2019) Staged Approach for Petroclival Meningioma Resection. J Neurol Surg B Skull Base 80(Suppl 3):S308–S309 PubMed PMC

Koka K, Patel BC (2019) Ptosis Correction. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

Kollová A, Liščák R, Novotný J, Vladyka V, Šimonová G, Janoušková L (2007) Gamma Knife surgery for benign meningioma. J Neurosurg. https://doi.org/10.3171/JNS-07/08/0325

Koutourousiou M, Fernandez-Miranda JC, Vaz-Guimaraes Filho F, Almeida WJR, EW S, CH G, P.A. (2017) Outcomes of Endonasal and Lateral Approaches to Petroclival Meningiomas. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.12.001

Krisht AF (2005) Transcavernous approach to diseases of the anterior upper third of the posterior fossa. Neurosurg Focus. https://doi.org/10.3171/foc.2005.19.2.3

Kunii N, Ota T, Kin T, Kamada K, Morita A, Kawahara N, Saito N (2011) Angiographic classification of tumor attachment of meningiomas at the cerebellopontine angle. World Neurosurg. https://doi.org/10.1016/j.wneu.2010.09.020

Kusumi M, Fukushima T, Mehta AI, Aliabadi H, Nonaka Y, Friedman AH, Fujii K (2012) Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas: Clinical article. J Neurosurg. https://doi.org/10.3171/2011.11.JNS11985

Labuschagne JJ, Chetty D (2019) Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report. Neurosurg Focus 46

Lall RR, Lall RR, Smith TR, Lee K-H, Mao Q, Kalapurakal JA, Marymont MH, Chandler JP (2014) Delayed malignant transformation of petroclival meningioma to chondrosarcoma after stereotactic radiosurgery. J Clin Neurosci 21(7):1225–1228 PubMed

Lawton MT, Daspit CP, Spetzler RF (1996) Transpetrosal and combination approaches to skull base lesions. Clin Neurosurg 43:91–112 PubMed

Lee HS, Kim JH, Lee JI (2012) Glioblastoma following radiosurgery for meningioma. J Korean Neurosurg Soc. https://doi.org/10.3340/jkns.2012.51.2.98

Lescher S, Samaan T, Berkefeld J (2014) Evaluation of the pontine perforators of the basilar artery using digital subtraction angiography in high resolution and 3D rotation technique. Am J Neuroradiol. https://doi.org/10.3174/ajnr.A3981

Lesueur P, Calugaru V, Nauraye C (2019) Proton therapy for treatment of intracranial benign tumors in adults: A systematic review. Cancer Treat Rev. https://doi.org/10.1016/j.ctrv.2018.11.004

Li D, Hao SY, Wang L, Tang J, Xiao XR, Jia GJ, Wu Z, Zhang LW, Zhang JT (2015) Recurrent petroclival meningiomas: clinical characteristics, management, and outcomes. Neurosurg Rev. https://doi.org/10.1007/s10143-014-0575-1

Li D, Hao S-Y, Wang L, Tang J, Xiao X-R, Zhou H, Jia G-J, Wu Z, Zhang L-W, Zhang J-T (2013) Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir (Wien) 155(8):1367–1383

Li P, Mao Y, Zhu W, Zhao N, Zhao Y, Chen L (2010) Surgical strategies for petroclival meningioma in 57 patients. Chin Med J (Engl) 123(20):2865–2873

Li D, Tang J, Ren C, Wu Z, Zhang LW, Zhang JT (2016) Surgical management of medium and large petroclival meningiomas: a single institution’s experience of 199 cases with long-term follow-up. Acta Neurochir. https://doi.org/10.1007/s00701-015-2671-6

Liao CH, Wang JT, Lin CF, Chen SC, Lin CJ, Hsu SPC, Chen MH (2018) Pretemporal trans-Meckel’s cave transtentorial approach for large petroclival meningiomas. Neurosurg Focus. https://doi.org/10.3171/2018.1.FOCUS17733

Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: Defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery. https://doi.org/10.1227/01.NEU.0000153906.12640.62

Ma J, Su S, Zhao Y, Chen X, Ma H (2016) Preoperative visualization of cranial nerves in skull base tumor surgery using diffusion tensor imaging technology. Turk Neurosurg 26:805–812 PubMed

Maclean J, Fersht N, Short S (2014) Controversies in Radiotherapy for Meningioma. Clin Oncol. https://doi.org/10.1016/j.clon.2013.10.001

Magill ST, Lee DS, Yen AJ, Lucas CHG, Raleigh DR, Aghi MK, Theodosopoulos PV, MW MD (2019) Surgical outcomes after reoperation for recurrent skull base meningiomas. J Neurosurg. https://doi.org/10.3171/2017.11.JNS172278

Magill ST, Rick JW, Chen WC, Haase DA, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW (2018) Petrous Face Meningiomas: Classification, Clinical Syndromes, and Surgical Outcomes. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.03.194

Martínez-Pérez R, Silveira-Bertazzo G, Rangel GG, Albiña P, Hardesty D, Carrau RL, Prevedello DM (2019) The historical perspective in approaches to the spheno-petro-clival meningiomas. Neurosurg Rev. https://doi.org/10.1007/s10143-019-01197-y

Masters LT, Nelson PK (1998) Pre-operative angiography and embolisation of petroclival meningiomas. Interv Neuroradiol. https://doi.org/10.1177/159101999800400305

Mastronardi L, Cacciotti G, Caputi F, Roperto R, Tonelli MP, Carpineta E, Fukushima T (2016) Underlay hourglass-shaped autologous pericranium duraplasty in “key-hole” retrosigmoid approach surgery: Technical report. Surg Neurol Int. https://doi.org/10.4103/2152-7806.178521

Mathiesen T, Gerlich Å, Kihlström L, Svensson M, Bagger-Sjöbäck D (2007) Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery. https://doi.org/10.1227/01.NEU.0000255476.06247.F1

Mathiesen T, Lindquist C, Kihlström L, Karlsson B (1996) Recurrence of cranial base meningiomas. Neurosurgery 39(1):2–7 discussion 8-9 PubMed

Maurer AJ, Safavi-Abbasi S, Cheema AA, Glenn CA, Sughrue ME (2014) Management of Petroclival Meningiomas: A Review of the Development of Current Therapy. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0034-1373657

Mayberg MR, Symon L (1986) Meningiomas of the clivus and apical petrous bone: Report of 35 cases. J Neurosurg. https://doi.org/10.3171/jns.1986.65.2.0160

Mc Dermott M (2011) Comment to Two staged approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev 34:171–179

Meling TR, Da Broi M, Scheie D, Helseth E, Smoll NR (2019) Meningioma Surgery–Are We Making Progress? World Neurosurg. https://doi.org/10.1016/j.wneu.2019.01.042

Mizutani K, Toda M, Yoshida K (2016) The Analysis of the Petrosal Vein to Prevent Venous Complications During the Anterior Transpetrosal Approach in the Resection of Petroclival Meningioma. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.06.018

Morisako H, Goto T, Ohata K (2015) Petroclival meningiomas resected via a combined transpetrosal approach: Surgical outcomes in 60 cases and a new scoring system for clinical evaluation. J Neurosurg. https://doi.org/10.3171/2014.8.JNS132406

Muto J, Prevedello DM, Filho LFSD, Tang IP, Oyama K, Kerr EE, Otto BA, Kawase T, Yoshida K, Carrau RL (2016) Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region. J Neurosurg. https://doi.org/10.3171/2015.8.JNS15302

Nanda A, Javalkar V, Banerjee AD (2011) Petroclival meningiomas: Study on outcomes, complications and recurrence rates - Clinical article. J Neurosurg. https://doi.org/10.3171/2010.11.JNS10326

Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: Multimodality treatment and outcomes at long-term follow-up. Neurosurgery. https://doi.org/10.1227/01.NEU.0000255472.52882.D6

Nicosia L, Di PS, Catapano M, Spadarella G, Sammut L, Cannataci C, Resta F, Reganati P (2019) Petroclival meningiomas: Radiological features essential for surgeons. ecancermedicalscience. https://doi.org/10.3332/ecancer.2019.907

Nishimura S, Hakuba A, Jang BJ, Inoue Y (1989) Clivus and apicopetroclivus meningiomas - Report of 24 cases. Neurol Med-Chir. https://doi.org/10.2176/nmc.29.1004

Oh H-J, Cho YH, Kim JH, Kim CJ, Kwon DH, Lee D, Yoon K (2020) Hypofractionated stereotactic radiosurgery for large-sized skull base meningiomas. J Neurooncol 149(1):87–93 PubMed

Orlev A, Jackson CM, Luksik A, Garzon-Muvdi T, Yang W, Chien W, Harnof S, Tamargo RJ (2020) Natural History of Untreated Transverse/Sigmoid Sinus Thrombosis Following Posterior Fossa Surgery. Case Series and Literature Review Operative neurosurgery (Hagerstown. https://doi.org/10.1093/ons/opz396

Panigrahi M, Vooturi S, Patibandla MR, Kulkarni D (2015) Novel classification for surgical approach of petroclival meningiomas: A single-surgeon experience. Neurol India. https://doi.org/10.4103/0028-3886.166551

Park CK, Jung HW, Kim JE, Paek SH, Kim DG (2006) The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol. https://doi.org/10.1016/j.surneu.2005.12.024

Passeri T, Champagne PO, Bernat AL, Hanakita S, Salle H, Mandonnet E, Froelich S (2019) Spontaneous regression of meningiomas after interruption of nomegestrol acetate: a series of three patients. Acta Neurochir. https://doi.org/10.1007/s00701-019-03848-x

Peyre M, Bozorg-Grayeli A, Rey A, Sterkers O, Kalamarides M (2012) Posterior petrous bone meningiomas: Surgical experience in 53 patients and literature review. Neurosurg Rev. https://doi.org/10.1007/s10143-011-0333-6

Pintea B, Kandenwein JA, Lorenzen H, Boström JP, Daher F, Velazquez V, Kristof RA (2018) Factors of influence upon the SF-36-based health related quality of life of patients following surgery for petroclival and lateral posterior surface of pyramid meningiomas. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2018.01.016

Pirayesh A, Petrakakis I, Raab P, Polemikos M, Krauss JK, Nakamura M (2016) Petroclival meningiomas: Magnetic resonance imaging factors predict tumor resectability and clinical outcome. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2016.06.002

Pollock BE, Link MJ, Stafford SL, Parney IF, Garces YI, Foote RL (2017) The Risk of Radiation-Induced Tumors or Malignant Transformation After Single-Fraction Intracranial Radiosurgery: Results Based on a 25-Year Experience. Int J Radiation Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2017.01.004

Qiao L, Yu C, Zhang H, Zhang M, Qu Y, Ren M, Gu C, Wang H (2019) Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection: An analysis of 176 cases. Cancer Manag Res. https://doi.org/10.2147/CMAR.S200932

Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PHP (2008) Surgical removal of small petroclival meningiomas. Acta Neurochir. https://doi.org/10.1007/s00701-007-1403-y

Roche PH, Pellet W, Fuentes S, Thomassin JM, Régis J (2003) Gamma knife radiosurgical management of petroclival meningiomas results and indications. Acta Neurochir. https://doi.org/10.1007/s00701-003-0123-1

Romani R, Ryan G, Benner C, Pollock J (2018) Non-operative meningiomas: long-term follow-up of 136 patients. Acta Neurochir. https://doi.org/10.1007/s00701-018-3554-4

Sadik ZHA, Te LS, Leenstra S, Hanssens PEJ (2018) Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery. J Neurosurg. https://doi.org/10.3171/2017.7.JNS17380

Samii M, Gerganov V, Giordano M, Samii A (2011) Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev 34(2):173–179

Samii M, Gerganov V, Giordano M, Samii A (2011) Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev. https://doi.org/10.1007/s10143-010-0299-9

Samii M, Tatagiba M (1992) Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir. https://doi.org/10.1007/BF01400723

Samii M, Tatagiba M, Carvalho GA (2000) Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome. J Neurosurg 92(2):235–241 PubMed

Sassun TE, Ruggeri AG, Delfini R (2016) True Petroclival Meningiomas: Proposal of Classification and Role of the Combined Supra-Infratentorial Presigmoid Retrolabyrinthine Approach. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.08.023

Schipmann S, Suero Molina E, Frasch A, Stummer W, Wiewrodt D (2018) Initial psycho-oncological counselling in neuro-oncology: analysis of topics and needs of brain tumour patients. J Neurooncol 136(3):505–514 PubMed

Seifert V (2010) Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: Personal experiences over a period of 20 years. Acta Neurochir. https://doi.org/10.1007/s00701-010-0633-6

Seifert V (2010) Comment to Two staged approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev 34:171–179

Sekhar LN, Schessel DA, Bucur SD, Raso JL, Wright DC (1999) Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area. Neurosurg 44(3):537–550 discussion 550-552

Sekhar LN, Wright DC, Richardson R, Monacci W (1996) Petroclival and foramen magnum meningiomas: Surgical approaches and pitfalls. J Neuro-Oncol. https://doi.org/10.1007/BF00165655

Sheehan J, Chun PY, Steiner L (2006) Gamma Knife surgery-induced meningioma: Report of two cases and review of the literature. J Neurosurg. https://doi.org/10.3171/jns.2006.105.2.325

Singh N, Singh D, Ahmad F, Kumar R (2019) The retrosigmoid approach: Workhorse for petroclival meningioma surgery. Asian J Neurosurg. https://doi.org/10.4103/ajns.ajns_192_18

Singla A, Deshaies EM, Melnyk V, Toshkezi G, Swarnkar A, Choi H, Chin LS (2013) Controversies in the role of preoperative embolization in meningioma management. FOC 35(6):E17

Spallone A, Konovalov AN, Mukhamedjanov DJ, Rizzo A (1997) Petroclival meningioma. the role of skull base approaches in their surgical management. Skull Base Surgery

Spetzler RF, Daspit CP, Pappas CTE (1992) The combined supra- and infratentorial approach for lesions of the petrous and clival regions: Experience with 46 cases. J Neurosurg. https://doi.org/10.3171/jns.1992.76.4.0588

Starke R, Kano H, Ding D et al (2014) Stereotactic radiosurgery of petroclival meningiomas: A multicenter study. J Neuro-Oncol. https://doi.org/10.1007/s11060-014-1470-x

Starnoni D, Daniel RT, Tuleasca C, George M, Levivier M, Messerer M (2018) Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: A “nerve-centered” approach. Neurosurg Focus. https://doi.org/10.3171/2017.12.FOCUS17669

Subach BR, Dade Lunsford L, Kondziolka D, Maitz AH, Flickinger JC (1998) Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery. https://doi.org/10.1097/00006123-199803000-00001

Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113(5):1036–1042 PubMed

Suzuki K, Nagaishi M, Matsumoto Y et al (2017) Preoperative Embolization for Skull Base Meningiomas. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0037-1598195

Tahara A, de Santana PA, Calfat Maldaun MV, Panagopoulos AT, da Silva AN, Zicarelli CA, Pires de Aguiar PH (2009) Petroclival meningiomas: Surgical management and common complications. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2008.08.011

Tamhankar MA, Ying GS, Volpe NJ (2011) Success of prisms in the management of diplopia due to fourth nerve palsy. J Neuro-Ophthalmol. https://doi.org/10.1097/WNO.0b013e318211daa9

Tao J, Wang Y, Qiu B, Ou S, Wang Y, Wu P (2014) Selection of surgical approaches based on semi-quantifying the skull-base invasion by petroclival meningiomas: A review of 66 cases. Acta Neurochir. https://doi.org/10.1007/s00701-014-2084-y

Tatagiba M, Carvalho GA, Samii M (1999) The retrosigmoid intradural suprameatal approach to the meckel’s cave and the middle fossa: surgical anatomy and applications. Skull Base Surg

Tatagiba M, Rigante L, Mesquita Filho P, Ebner FH, Roser F (2015) Endoscopic-assisted posterior intradural petrous apicectomy in petroclival meningiomas: A clinical series and assessment of perioperative morbidity. World Neurosurg. https://doi.org/10.1016/j.wneu.2015.07.033

Tatagiba M, Samii M, Matthies C, Vorkapic P (1996) Management of Petroclival Meningiomas: A Critical Analysis of Surgical Treatment. Acta Neurochir, Supplement 1996(65):92–94

Terasaka S, Asaoka K, Kobayashi H, Yamaguchi S, Sawamura Y (2010) Natural history and surgical results of petroclival meningiomas. Neurol Surg

Van Gompel JJ, Alikhani P, Tabor MH, van Loveren HR, Agazzi S, Froelich S, Youssef AS (2014) Anterior inferior petrosectomy: defining the role of endonasal endoscopic techniques for petrous apex approaches. J Neurosurg 120(6):1321–1325 PubMed

Van Havenbergh T, Carvalho G, Tatagiba M et al (2003) Natural history of petroclival meningiomas. Neurosurgery 52(1):55–64 PubMed

Watanabe T, Katayama Y, Fukushima T, Kawamata T (2011) Lateral supracerebellar transtentorial approach for petroclival meningiomas: Operative technique and outcome: Clinical article. J Neurosurg. https://doi.org/10.3171/2011.2.JNS101759

Wayhs SY, Lepski GA, Frighetto L, Isolan GR (2017) Petroclival meningiomas: Remaining controversies in light of minimally invasive approaches. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2016.11.021

Xiao X, Zhang L, Wu Z, Zhang J, Jia G, Tang J, Meng G (2013) Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach. Neurosurg Rev. https://doi.org/10.1007/s10143-013-0484-8

Yamahata H, Tokimura H, Hirahara K, Ishii T, Mori M, Hanaya R, Arita K (2014) Lateral suboccipital retrosigmoid approach with tentorial incision for petroclival meningiomas: Technical note. J Neurol Surg, Part B: Skull Base. https://doi.org/10.1055/s-0034-1373656

Yamakami I, Higuchi Y, Horiguchi K, Saeki N (2011) Treatment policy for petroclival meningioma based on tumor size: Aiming radical removal in small tumors for obtaining cure without morbidity. Neurosurg Rev. https://doi.org/10.1007/s10143-011-0308-7

Yang J, Fang T, Ma S, Yang S, Qi J, Qi Z, Cun E, Yu C (2011) Large and giant petroclival meningiomas: therapeutic strategy and the choice of microsurgical approaches - report of the experience with 41 cases. Br J Neurosurg 25(1):78–85 PubMed

Yao A, Pain M, Balchandani P, Shrivastava RK (2018) Can MRI predict meningioma consistency?: a correlation with tumor pathology and systematic review. Neurosurg Rev 41(3):745–753 PubMed

Yaşargil MG, Mortara RW, Curcic M (1980) Meningiomas of Basal Posterior Cranial Fossa. Adv Tech Stand Neurosurg 7:3–115

Zada G, Day JD, Giannotta SL (2008) The extradural temporopolar approach: A review of indications and operative technique. Neurosurg Focus. https://doi.org/10.3171/FOC.2008.25.12.E3

Zamanipoor Najafabadi AH, Peeters MCM, Dirven L, Lobatto DJ, Groen JL, Broekman MLD, Peerdeman SM, Peul WC, Taphoorn MJB, van Furth WR (2017) Impaired health-related quality of life in meningioma patients-a systematic review. Neuro Oncol 19(7):897–907 PubMed

Zeng L, Liang P, Jiao J, Chen J, Lei T (2015) Will an Asymptomatic Meningioma Grow or Not Grow? A Meta-analysis. J Neurol Surg, Part A: Central Eur Neurosurg. https://doi.org/10.1055/s-0034-1543959

Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J (1997) Petroclival meningiomas: Is radical resection always the best option? J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp.62.4.341

Zhao Z, Yuan X, Yuan J, Cai L, Jiang W, Xie Y, Wanggou S (2020) Treatment Strategy for Petroclival Meningiomas Based on a Proposed Classification in a Study of 168 Cases. Sci Rep 10(1):4655 PubMed PMC

Zhou QJ, Liu B, Geng DJ, Fu Q, Cheng XJ, Kadeer K, Du GJ, Wang YX, Luan XP (2015) Microsurgery with or without neuroendoscopy in petroclival meningiomas. Turkish Neurosurg. https://doi.org/10.5137/1019-5149.JTN.8670-13.1