Surgical treatment for CM without syringomyelia is still under debate. The aim of this study was to evaluate the long term outcome of surgically treated patients for CM-I without syringomyelia. We selected all adult patients who underwent surgery for CM-I without syringomyelia between 1993 and 2010. Only patients with long term follow-up (>5 years) were included. Clinical manifestations, radiologic features, and follow-up data were analyzed. Patient's outcome was assessed using the Chicago Chiari Outcome Scale (CCOS). Patient's outcome was classified also as: "improved", "unchanged"or "worse". Among 38 patients, 27 were females and 11 were males. Age ranged from 18 to 65 years (mean age 41 years). The average follow-up duration was 75 months (range 60-168 months). The most frequent symptoms of presentation were: headache (60%), neck pain (52.6%), postural or gait instability (47.3 %), upper limb paresthesias (44.7%). The most frequent signs of presentation were: nystagmus (44.7%), pyramidal signs (31.5 %), gait/balance impairment (23.6 %). Surgical treatment resulted in a long term success rate of 84.2% (32 patients improved at last follow-up). 31 patients (81.5%) achieved a CCOS score between 13 and 16. Headache improved in 86.9 % of patients, gait impairment in 83.3 %, paresthesias in 70% and neck pain in 65.2 %. Two patients (5.2%) were unchanged after surgery, four patients (10.5%) showed recurrence of their symptoms. There was no mortality. Surgery is a safe and long term effective treatment for patients with CM-I without syringomyelia in the majority of patients.

Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or temporal lobe injury. We aimed to evaluate the morbidity of the standard combined petrosal approach (CPA), defined as a combination of the posterior (retrolabyrinthine) and the anterior petrosal approach. We performed a systematic review and meta-analysis of articles reporting on clinical series of patients operated on for petroclival meningiomas through CPA. Studies that used the terminology “combined petrosal approach” without matching the aforementioned definition were excluded as well as clinical series that included less than 5 patients. A total of 8 studies were included involving 160 patients. The pooled complication rates were 3% (95% CI, 0.5–5.6) for CSF leak, 8.6% (95% CI, 4.1–13.2%) for facial palsy, 8.2% (95% CI, 3.9–12.6%) for hearing impairment, 2.8% (95% CI, 0.9–6.5%) for venous complications, and finally 4.8% (95%, 1.2–8.4%) for temporal lobe injury. Contrary to the general belief, CPA is associated with an acceptable rate of complications, especially when compared to alternative approaches to the petroclival area. In view of the major advantages like shorter trajectory, multiple angles of surgical attack, and early tumor devascularization, CPA remains an important tool in the armamentarium of the skull base surgeon.