Abstract
Background Meningiomas arising from the petroclival area remain a challenge for neurosurgeons.
Various approaches have been proposed to achieve maximum resection with minimal morbidity
and mortality. Also, some articles correlated preservation of adjacent veins with
less neurologic deficits.
Objective To describe the experiences in using a new technique to achieve maximal resection
of petroclival meningiomas and preserving the superior petrosal veins (SPVs) and the
superior petrosal sinus (SPS).
Methods A retrospective analysis of 26 patients harboring a true petroclival meningioma with
a diameter ≥25 mm and undergoing surgery with the modified transpetrosal–transtentorial
approach (MTTA) was performed.
Results Fifty-four percent of 22 patients complained of severe headache at presentation.
There was also complaint of cranial nerve (CN) deficit, with CN VII deficit being
the most common (present in 42% of patients). The average tumor size (measured as
maximum diameter) was 45.2 mm, and most of the tumors compressed the brainstem. Total
resection was achieved in 12 patients (46.2%), whereas the others were excised subtotally
(54.8%). Most of the patients had WHO grade I (96.1%) meningioma; only one had a grade
II (3.8%) meningioma. In addition, clinical improvement and persistence of symptoms
were observed in 17 (65.4%) and 8 (30.7%) patients, respectively, and postoperative
permanent CN injury was observed in 3 (11.5%) patients.
Conclusion Using the MTTA, maximal resection with preservation of the CNs and neurovascular
SPV-SPS complex can be achieved. Therefore, further studies and improvements of the
technique are required to increase the total resection rate without neglecting the
complications that may develop postoperatively.
Keywords
Petroclival meningioma - superior petrosal vein - superior petrosal sinus - modified
transpetrosal-transtentorial approach
