Radical excision of meningioma is suggested to provide for the best tumor control rates. However, aggressive surgery for meningiomas located at the posterior cranial fossa may lead to elevated postoperative morbidity of adjacent cranial nerves which in turn worsens patients' postoperative quality of life. Therefore, we analyzed our institutional database with regard to new cranial nerve dysfunction as well as postoperative cerebrospinal fluid (CSF) leakage depending on the extent of tumor resection. Between 2009 and 2017, 89 patients were surgically treated for posterior fossa meningioma at the authors' institution. Postoperative new cranial nerve dysfunction as well as CSF leakage were stratified into Simpson grade I resections with excision of the adjacent dura as an aggressive resection regime versus Simpson grade II-IV tumor removal. Simpson grade I resections revealed a significantly higher percentage of new cranial nerve dysfunction immediately after surgery (39%) compared with Simpson grade II (11%, p = 0.01) and Simpson grade II-IV resections (14%, p = 0.02). These observed differences were also present for the 12-month follow-up (27% Simpson grade I, 3% Simpson grade II (p = 0.004), 7% Simpson grades II-IV (p = 0.01)). Postoperative CSF leakage was present in 21% of Simpson grade I and 3% of Simpson grade II resections (p = 0.04). Retreatment rates did not significantly differ between these two groups (6% versus 8% (p = 1.0)). Elevated levels of postoperative new cranial nerve deficits as well as CSF leakage following radical tumor removal strongly suggest a less aggressive resection policy to constitute the surgical modality of choice for posterior cranial fossa meningiomas.

中文翻译：

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颅后窝脑膜瘤的手术：颅神经术后并发症的高发性放弃了积极的肿瘤切除政策。

建议根治性切除脑膜瘤可提供最佳的肿瘤控制率。然而，对位于颅后窝的脑膜瘤进行积极的手术可能会导致邻近颅神经的术后发病率升高，进而恶化患者的术后生活质量。因此，我们根据肿瘤切除的程度分析了关于新的颅神经功能障碍以及术后脑脊液（CSF）渗漏的机构数据库。在2009年至2017年之间，作者所在机构对89例因后颅窝脑膜瘤进行手术治疗。术后将新的颅神经功能障碍以及脑脊液渗漏分为辛普森Ⅰ级切除术，同时切除邻近硬脑膜作为积极的切除方案，而不是辛普森Ⅱ-IV级肿瘤切除术。与辛普森II级手术（11％，p = 0.01）和辛普森II-IV级手术（14％，p = 0.02）相比，辛普森I级手术切除后立即出现新的颅神经功能障碍的比例（39％）明显更高。这些观察到的差异在12个月的随访中也存在（27％的辛普森I级，3％的II级辛普森（p = 0.004），7％的II-IV级Simpson（p = 0.01））。术后21％的Simpson I级和3％的Simpson II级切除存在脑脊液渗漏（p = 0.04）。两组的再治疗率无显着差异（6％对8％（p = 1.0））。