Mortality and morbidity in surgically treated patients with petroclival meningiomas: a systematic review and meta-analysis of case series

Br J Neurosurg. 2022 Aug;36(4):501-10. doi: 10.1080/02688697.2022.2033700. Epub 2022 Feb 3.

Abstract

Background: Reports on petroclival meningioma (PCM) surgical mortality and morbidity often deviate from established standards; as such, a comprehensive summary is lacking.

Methods: Eligibility/sources. Peer-reviewed case series of at least 10 PCM patients identified from PubMed, Web of Science, Ovid, or Google Scholar. Outcomes. Primary: mortality, tumor recurrence, any cranial nerve deficit (CND); other: individual CNDs, other complications. Data synthesis. Random-effects meta-analysis/meta-regression [effects: surgical approach (supratentorial, S; infratentorial, I; combined, (C), average age and follow-up, sample size, and percent of patients with gross-total resection (GTR)] of logit-transformed proportions.

Results: Data. 73 case-series/3553 patients. Mortality. Adjusted predicted mortalities of 2.4%, 2.5%, and 1.2% (50-month follow-up) for the S, I, and C approaches, respectively, with the upper limits of the 95% credibility intervals at 3.3%, 3.7%, and 3.6%, respectively. Recurrence. Adjusted predicted recurrences of 5.5%, 11.1%, and 12.0% (50-month follow-up and 57% GTR) for the S, I, and C approaches, respectively; recurrence was positively associated with follow-up period and negatively associated with having received GTR. At all covariates at median values but at GTR 90% predictions: 3.1% (95%CI 3.1-9.8), 6.3% (3.8-10.4), and 6.9% (3.4-13.2) with the S, I, and C; prediction credibility intervals 1-4% and 22.4%. Any CND. Adjusted predicted probabilities of 37.2%, 23.4%, and 29.5% (at median covariate values) for the S, I, and C approaches, respectively; prediction credibility intervals ranged from <10% to 78%. Other outcomes. The most common individual CNDs were nVII (14.4%), nV (11.5%), and nIII (10.2%); other common complications included motor deficit (10.8%), infection (9.8%), and CSF leak (7.5%).

Conclusion: This is the first systematic review on PCM surgical mortality, recurrence, and morbidity. Outcomes differ between surgical approaches and reporting quality varies greatly.

Keywords: Meta-analysis; outcome; petroclival meningioma; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Meningeal Neoplasms* / pathology
  • Meningeal Neoplasms* / surgery
  • Meningioma* / pathology
  • Morbidity
  • Neurosurgical Procedures / adverse effects
  • Retrospective Studies
  • Skull Base Neoplasms* / pathology
  • Skull Base Neoplasms* / surgery
  • Treatment Outcome