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Combined retrosigmoid and middle fossa approach for a small, superiorly located petroclival meningioma: how I do it

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Abstract

Background

Petroclival meningiomas pose significant surgical challenges because of their deep location and complex surrounding neurovasculature. The use of multiple surgical approaches can optimize safe tumor removal from multiple anatomic compartments.

Method

We describe a patient with a growing superior petroclival meningioma centered at the posterior clinoid with extension into Meckel’s cave that was successfully removed with a combined retrosigmoid and subtemporal middle fossa approach. This strategy avoided the need for anterior petrous bone drilling and tentorial splitting.

Conclusion

A combined retrosigmoid and subtemporal middle fossa approach can provide safe access to tumors spanning the supra- and infratentorial compartments.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Robert C. Rennert, Karol P. Budohoski, Vance R. Mortimer & William T. Couldwell

Authors
  1. Robert C. Rennert
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  2. Karol P. Budohoski
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  3. Vance R. Mortimer
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  4. William T. Couldwell
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Contributions

Robert C. Rennert: methodology, writing-original draft, visualization.

Karol P. Budohoski: writing-review and editing.

Vance R. Mortimer: visualization, writing-review and editing.

William T. Couldwell: conceptualization, resources, supervision, project administration, writing-review and editing.

Corresponding author

Correspondence to William T. Couldwell.

Ethics declarations

Ethical approval

Approval from the institutional review board is waived for case reports. All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Utah and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

The patient consented to participate.

Consent for publication

The patient consented to the publication of her case in this paper.

Competing interests

The authors declare no competing interests.

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Publisher's Note

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Key points

• Petroclival tumors often span anatomic compartments and can require multiple surgical approaches.

• Familiarity with the limits of described approaches to the petroclival region is critical.

• The combined retrosigmoid and subtemporal middle fossa approach provides multicompartment access.

• The retrosigmoid approach provides access along the long axis of the tumor up to the level of the posterior clinoid.

• Drilling of the suprameatal tubercle can widen the retrosigmoid corridor.

• The middle fossa approach provides access to Meckel’s cave without anterior petrous removal and transgression of the tentorium.

• Avoiding tentorial splitting limits risk to the trochlear nerve.

• Maintenance of a bony bridge on the transverse-sigmoid junction minimizes risk of venous injury.

• Watertight dural closure, fat grafting, and cerebrospinal fluid drainage can reduce the risk of wound complications.

• The patient should understand the risks of petroclival tumor surgery and need for follow-up.

Supplementary Information

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Rennert, R.C., Budohoski, K.P., Mortimer, V.R. et al. Combined retrosigmoid and middle fossa approach for a small, superiorly located petroclival meningioma: how I do it. Acta Neurochir 165, 2931–2935 (2023). https://doi.org/10.1007/s00701-023-05775-4

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  • DOI: https://doi.org/10.1007/s00701-023-05775-4

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