Surgical risk score of petro-clival meningiomas

Sixty-six cases of petro-clival meningiomas were operated, mainly by the transpetrosal approach. The surgical risk factors were scored by following factors: 1) tumor location (pyramid, clivus, parasellar), 2) size of the tumor base, 3) tumor consistency, 4) arterial involvement, and 5) brainstem involvement on MRI T2 image. The surgical risk score (1-10 points) was calculated retrospectively. The tumor disappeared totally in 71%. There was no mortality, and 89% of the patients were independent. Seven patients (11%) were disabled mainly by the brain stem infarction. The total tumor resection was not risky in patients scoring 0-4, a challenge when scored 5-6, and was high risk or impossible in patients who scored more than 7. For the high risk patients, the tumor, adhesive to the brain stem or to the carotid artery in the cavernous sinus, might partially be left to avoid the surgical risks.