{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:49:18Z","timestamp":1788814158087,"version":"build-2803163510"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O.A.) from 1988 to 2012, strictly defined as those originating medial to the fifth cranial nerve on the upper two-thirds of the clivus. The patients' average age was 49 years; the average tumor size (maximum diameter) was 35.48 \u00b1 10.09 mm (with 59 tumors &gt; 20 mm), and cavernous sinus extension was present in 39 patients. The mean duration of follow-up was 71.57 months (range 4\u2013276 months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 42 patients, the operative reports allowed the grading of resection. Grade I resection (tumor, dura, and bone) was achieved in 17 patients (40.4%); there was no recurrence in this group (p = 0.0045). Grade II (tumor, dura) was achieved in 15 patients (36%). There was a statistically significant difference in the rate of recurrence with respect to resection grade (Grades I and II vs other grades, p = 0.0052). In all patients, tumor removal was classified based on postoperative contrast-enhanced MRI, and gross-total resection (GTR) was considered to be achieved if there was no enhancement present; on this basis, GTR was achieved in 41 (64%) of 64 patients, with a significantly lower recurrence rate in these patients than in the group with residual enhancement (p = 0.00348). One patient died from pulmonary embolism after discharge.<\/jats:p>\n                    <jats:p>The mean Karnofsky Performance Status (KPS) score was 85.31 preoperatively (median 90) and improved on follow-up to 88, with 30 patients (47%) having an improved KPS score on follow-up. Three patients suffered a permanent deficit that significantly affected their KPS. Cerebrospinal fluid leak occurred in 8 patients (12.5%), with 2 of them requiring exploration. Eighty-nine percent of the patients had cranial nerve deficits on presentation; of the 54 patients with more than 2 months of follow-up, 21 (32.8%) had persisting cranial nerve deficits. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6.2%. There was no difference with respect to immediate postoperative cranial nerve deficit in patients who had GTR compared with those who had subtotal resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2013.8.jns13535","type":"journal-article","created":{"date-parts":[[2013,10,25]],"date-time":"2013-10-25T10:27:00Z","timestamp":1382696820000},"page":"40-51","source":"Crossref","is-referenced-by-count":145,"title":["True petroclival meningiomas: results of surgical management"],"prefix":"10.3171","volume":"120","author":[{"given":"Rami","family":"Almefty","sequence":"first","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Pravdenkova","sequence":"additional","affiliation":[{"name":"Arkansas Neurological Institute, Little Rock, Arkansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abolfotoh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;"},{"name":"Department of Neurosurgery, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns13535","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","author":"Abdel Aziz","year":"2000"},{"issue":"ONS Suppl 1","key":"b2-jns13535","series-title":"Neurosurgery","first-page":"ons16","article-title":"Transmastoid retrosigmoid approach to the cerebellopontine angle: surgical technique","volume":"73","author":"Abolfotoh","year":"2013"},{"key":"b3-jns13535","series-title":"Nihon Ganka Kiyo","first-page":"403","article-title":"[VER of the intracranial lesion and its clinical evaluation.]","volume":"22","author":"Adachi","year":"1971"},{"key":"b4-jns13535","series-title":"Operative Atlas of Meningiomas","author":"Al-Mefty","year":"1998"},{"key":"b5-jns13535","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1227\/00006123-198803000-00010","article-title":"Petrosal approach for petroclival meningiomas","volume":"22","author":"Al-Mefty","year":"1988"},{"key":"b6-jns13535","series-title":"Meningiomas","first-page":"517","article-title":"Clival and petroclival meningiomas","author":"Al-Mefty","year":"1991"},{"issue":"5 Suppl 2","key":"b7-jns13535","series-title":"Neurosurgery","first-page":"202","article-title":"Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review","volume":"61","author":"Bambakidis","year":"2007"},{"key":"b8-jns13535","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1227\/00006123-199211000-00001","article-title":"Microsurgical removal of petroclival meningiomas: a report of 33 patients","volume":"31","author":"Bricolo","year":"1992"},{"key":"b9-jns13535","series-title":"Acta Radiol Suppl","first-page":"1","article-title":"Meningiomas of the posterior fossa","volume":"104","author":"Castellano","year":"1953"},{"key":"b10-jns13535","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1212\/WNL.16.1.86","article-title":"Clivus meningiomas","volume":"16","author":"Cherington","year":"1966"},{"key":"b11-jns13535","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3171\/jns.1996.84.1.0020","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","author":"Couldwell","year":"1996"},{"key":"b12-jns13535","series-title":"Meningiomas of the cerebellar chamber: Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results","first-page":"169","year":"1938"},{"key":"b13-jns13535","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3171\/jns.1994.81.2.0245","article-title":"Outcome of aggressive removal of cavernous sinus meningiomas","volume":"81","author":"DeMonte","year":"1994"},{"key":"b14-jns13535","series-title":"Skull Base","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1055\/s-0030-1253581","article-title":"Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era","volume":"20","author":"Diluna","year":"2010"},{"issue":"2","key":"b15-jns13535","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical management of petroclival meningiomas: factors determining the choice of approach","volume":"19","author":"Erkmen","year":"2005"},{"key":"b16-jns13535","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.surneu.2003.12.008","article-title":"Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases","volume":"62","author":"Goel","year":"2004"},{"key":"b17-jns13535","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.3171\/2010.6.JNS091461","article-title":"Preservation of the superior petrosal sinus during the petrosal approach. 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