Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension
- 26 November 2010
- journal article
- Published by Springer Science and Business Media LLC in Neurosurgical Review
- Vol. 34 (2), 173-179
- https://doi.org/10.1007/s10143-010-0299-9
Abstract
The treatment of petroclival meningiomas is still a matter of controversy in literature. In the last decades, many approaches have been introduced. Our strategy for the treatment of such tumors having large supratentorial extension with encasement of the internal carotid artery or compression of optic and oculomotor nerves has evolved in the attempt to improve the outcome. Currently, we favor a surgical technique consisting of two steps. As first step, we perform a retrosigmoid suprameatal approach in order to resect the posterior part of the tumor and obtain brainstem decompression. In the second step, carried out after patient's recovery from the first surgery, we remove the supratentorial portion of the lesion using a frontotemporal craniotomy to achieve the decompression of the optic nerve, oculomotor nerve, and carotid artery. The retrosigmoid suprameatal approach allows for adequate brainstem decompression: the tumor itself creates a surgical channel increasing the accessibility to the lower and upper petroclival surface. Moreover, this route allows for early visualization of cranial nerves in the posterior fossa and safe tumor removal under direct visual control, reducing the risk of postoperative deficits. Via the simple and safe frontotemporal craniotomy, the supratentorial part of the lesion can be removed thus avoiding the need of invasive approaches. We propose a two-stage surgery for treatment of petroclival meningiomas combining two simple routes such as retrosigmoid suprameatal and frontotemporal craniotomy. This approach reflects our philosophy to use simple and less invasive approaches in order to preserve neurological function and a good quality of life of the patient.Keywords
This publication has 34 references indexed in Scilit:
- Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomasEuropean Journal of Surgical Oncology, 2009
- SURGERY OF EXTRA-AXIAL TUMORS OF THE CEREBRAL BASENeurosurgery, 2008
- QUANTITATIVE ANALYSIS OF EXPOSURE OF STAGED ORBITOZYGOMATIC AND RETROSIGMOID CRANIOTOMIES FOR LESIONS OF THE CLIVUS WITH SUPRATENTORIAL EXTENSIONOperative Neurosurgery, 2008
- EVOLUTION OF SURGICAL APPROACHES IN THE TREATMENT OF PETROCLIVAL MENINGIOMASOperative Neurosurgery, 2007
- Gamma knife radiosurgical management of petroclival meningiomas results and indicationsActa Neurochirurgica, 2003
- Impact of Computed Tomographic and Magnetic Resonance Imaging Findings on Surgical Outcome in Petroclival MeningiomasNeurosurgery, 2000
- MENINGIOMASNeurosurgery Quarterly, 1991
- Reconstruction of the temporalis muscle for the pterional craniotomyJournal of Neurosurgery, 1990
- The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. surgical technique and clinical applicationsActa Neurochirurgica, 1988
- Petrosal Approach for Petroclival MeningiomasNeurosurgery, 1988