Combined petrosal approach for resection of a large left petroclival meningioma

Francesco Paglia; Lorenzo Giammattei; Paolo di Russo; Sebastien Froelich

doi:10.3171/2022.1.FOCVID21226

Combined petrosal approach for resection of a large left petroclival meningioma

Neurosurg Focus Video. 2022 Apr 1;6(2):V6. doi: 10.3171/2022.1.FOCVID21226. eCollection 2022 Apr.

Authors

Francesco Paglia¹, Lorenzo Giammattei¹, Paolo di Russo¹, Sebastien Froelich¹

Affiliation

¹ Department of Neurosurgery, Lariboisiere Hospital, Paris Diderot University, Paris, France.

Abstract

Petroclival meningiomas represent the most complex lesions in skull base surgery, being closely related to critical neurovascular structures. The combined petrosal approach allows a wide exposure of the petroclival region and provides multiple angles of attack, limiting brain retraction. The authors present the case of a 54-year-old man with a large left petroclival meningioma responsible for headaches, dysphagia, and trigeminal neuralgia. The lesion was resected using a combined petrosal approach. A progressive improvement of the preoperative symptoms was observed. Postoperative MRI showed a near-total resection of the tumor, along with reexpansion of the brainstem. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21226.

Keywords: Labbé vein; combined petrosal approach; cosmetic mastoidectomy; petroclival meningioma; semicircular canals; superior petrosal sinus; tentorial cutting; transverse-sigmoid junction.