Cranial nerves palsy in the surgery of cerebello-pontine angle meningiomas

A surgical series of 15 patients with cerebellopontine angle meningiomas between 1990-1997 has been reviewed. Preoperative cranial nerve palsy was present in 10 cases. A retrosigmoid suboccipital approach was performed in 14 cases, subtemporal transtentorial in one case. Total removal was achieved in 13 cases, subtotal in 2. There was no surgical mortality. Two patients suffered new cranial nerve palsy (IVth and VIth nerve) as a result of the operation (improved at follow-up). Worsening of preoperative facial nerve palsy occurred in 3 cases, improvement of pre-operative palsy of cranial nerves (Vth, VIIth, XIth-Xth) occurred in 5 cases. In our experience it was more difficult to recognize and preserve the fourth and sixth nerve than other cranial nerves when the attachment and the extension of the tumor was in the cranial and caudal direction and toward the lateral clivus.