Combined Subtemporal and Retrosigmoid Keyhole Approach for Extensive Petroclival Meningiomas Surgery: Report of Experience with 7 Cases

Abstract

Objective: The resection of petroclival meningiomas offers great challenges to the neurosurgeon. Surgery via a combined subtemporal and retrosigmoid keyhole approach surgery was evaluated for the treatment of extensive petroclival meningiomas on the basis of our experience with 7 cases.

Methods: From July 2002 to July 2005, the resections of 7 petroclival meningiomas, which involved both supra- and infra-tentorial regions, were performed via a combined subtemporal and retrosigmoid keyhole approach. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated.

Results: The maximum diameter of tumors ranged from 3.4 to 6.0 cm (mean: 4.4 cm). Gross total resection (GTR) was achieved in 3 cases, giving a GTR rate of 43%. Subtotal resection (STR) was carried out in 4 cases. Neurological status remained intact in one case, while the others presented with cranial nerve deficits (VII, VI, V, III and lower CN). No death was reported during the postoperative period.

Conclusion: This combined keyhole approach is suitable for the treatment of extensive petroclival meningiomas. It provides easy and quick access to the supra- and infratentorial juxta-clival regions without any petrous bone drilling. Complications related to the approach can be minimized.

keyhole surgery - petroclival meningioma - subtemporal approach - retrosigmoid approach

References

• 1 Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: Surgical experience in 109 cases.  J Neurosurg. 1996;  84 20-28
• 2 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: Surgical method and results in 10 patients.  Neurosurgery. 1991;  28 869-876
• 3 Tatagiba M, Samii M, Mathies C, Vorkapic P. Management of petroclival meningiomas: A critical analysis of surgical treatment.  Acta Neurochir Suppl (Wein). 1996;  65 92-94
• 4 Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura T. Clivas meningioma: six cases of total removal.  Neurol Med Chir (Tokyo). 1977;  17 63-77
• 5 Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas.  Surg Neurol. 1988;  30 108-116
• 6 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach.  Neurosurg Focus. 2005;  19 ((2)) E7
• 7 Kawase T, Toya S, Shiobara R, Mine T. transpetrosal approach to aneurysms of the lower basilar artery.  J Neurosurg. 1989;  63 857-861
• 8 Cho CW, Al-Mefty O. Combined petrosal approach to petroclival meningiomas.  Neurosurgery. 2002;  51 708-718
• 9 Raabe SA, Zimmermann M. Conservative (labyrinth-preserving) transpetrosal approach to the clivus and petroclival region - indications, complications, results and lessons learned.  Acta Neurochir (Wien). 2003;  145 631-642
• 10 Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J. Petroclival meningiomas: Is radical resection always the best option?.  J Neurol Neurosurg Psychiatry. 1997;  62 341-345
• 11 Linskey ME, Davis SA, Ratanatharathorn V. Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities.  J Neurosurg. 2005;  102 ((Suppl)) 59-70
• 12 Ahn ES, Chin LS, Gyure KA, Hudes RS, Ragheb J, DiPatri Jr AJ. Long-term control after resection and gamma knife surgery of an intracranial clear cell meningioma: case report.  J Neurosurg. 2005;  102 ((3 Suppl)) 303-306

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