Microsurgical resection of skull base meningioma—expanding the operative corridor


A better understanding of surgical anatomy, marked improvement in illumination devices, provision of improved hemostatic agents, greater availability of more precise surgical instruments, and better modalities for skull base reconstruction have led to an inevitable evolution of skull base neurosurgery. For the past few decades, many skull base neurosurgeons have worked relentlessly to improve the surgical approach and trajectory for the expansion of operative corridor. With the advent of newer techniques and their rapid adaptation, it is foundational, especially for young neurosurgeons, to understand the basics and nuances of modifications of traditional neurosurgical approaches. The goal of this topic review is to discuss the evolution of, concepts in, and technical nuances regarding the operative corridor expansion in the field of skull base surgery for intracranial meningioma as they pertain to achieving optimal functional outcome.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    Spetzler RF, Sanai N (2012) The quiet revolution: retractorless surgery for complex vascular and skull base lesions. J Neurosurg 116:291–300

  2. 2.

    Altay T, Couldwell WT (2012) The frontotemporal (pterional) approach: an historical perspective. Neurosurgery 71:481–491

  3. 3.

    Mishra S, Srivastava AK, Kumar H, Sharma BS (2015) Reshaping the zygomatic complex: a “small step” in frontotemporal craniotomy and a “big leap” in exposure. Neurol India 63:723–726

  4. 4.

    Pellerin P, Lesoin F, Dhellemmes P, Donazzan M, Jomin M (1984) Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery 15:715–718

  5. 5.

    Hakuba A, Tanaka K, Suzuki T, Nishimura S (1989) A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 71:699–704

  6. 6.

    Zabramski JM, Kiris T, Sankhla SK, Cabiol J, Spetzler RF (1998) Orbitozygomatic craniotomy. Technical note. J Neurosurg 89:336–341

  7. 7.

    Gupta SK, Sharma BS, Pathak A, Khosla VK (2001) Single flap fronto-temporo-orbito-zygomatic craniotomy for skull base lesions. Neurol India 49:247–252

  8. 8.

    Tessier P, Guiot G, Derome P (1973) Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg 7:39–58

  9. 9.

    Derome P (1972) Spheno-ethmoidal tumors. Possibilities for exeresis and surgical repair. Neurochirurgie 18(Suppl 1):1–164

  10. 10.

    Feiz-Erfan I, Spetzler RF, Horn EM, Porter RW, Beals SP, Lettieri SC, Joganic EF, Demonte F (2008) Proposed classification for the transbasal approach and its modifications. Skull Base 18:29–47

  11. 11.

    Feiz-Erfan I, Han PP, Spetzler RF, Horn EM, Klopfenstein JD, Porter RW, Ferreira MA, Beals SP, Lettieri SC, Joganic EF (2005) The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 103:485–490

  12. 12.

    Liu JK, Decker D, Schaefer SD, Moscatello AL, Orlandi RR, Weiss MH, Couldwell WT (2003) Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Neurosurgery 53:1126–1135

  13. 13.

    Liu J, Amini A, Orlandi R, Weiss M, Couldwell W (2010) The role of transsphenoidal surgery in the management of complex lesions involving the skull base. In: Laws E, Lanzino G (eds) Transsphenoidal surgery. Elsevier, Philadelphia

  14. 14.

    Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869–875

  15. 15.

    Cho CW, Al-Mefty O (2002) Combined petrosal approach to petroclival meningiomas. Neurosurgery 51:708–716

  16. 16.

    Tripathi M, Deo RC, Suri A, Srivastav V, Baby B, Kumar S, Kalra P, Banerjee S, Prasad S, Paul K, Roy TS, Lalwani S (2015) Quantitative analysis of the Kawase versus the modified Dolenc–Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg 123:14–22

  17. 17.

    Heros RC (1986) Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64:559–562

  18. 18.

    Bertalanffy H, Seeger W (1991) The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29:815–821

  19. 19.

    Sen CN, Sekhar LN (1991) Surgical management of anteriorly placed lesions at the craniocervical junction–an alternative approach. Acta Neurochir (Wien) 108:70–77

  20. 20.

    George B, Dematons C, Cophignon J (1988) Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note. Surg Neurol 29:484–490

  21. 21.

    Suhardja A, Agur AM, Cusimano MD (2003) Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches. Neurosurg Focus 14(6):e9

  22. 22.

    Babu RP, Sekhar LN, Wright DC (1994) Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg 81:49–59

  23. 23.

    Patel SK, Husain Q, Eloy JA, Couldwell WT, Liu JK (2012) Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection and preservation of transsphenoidal surgery. Neurosurg Focus 33(2):E6

  24. 24.

    Schmidt RF, Choudhry OJ, Takkellapati R, Eloy JA, Couldwell WT, Liu JK (2012) Hermann Schloffer and the origin of transsphenoidal pituitary surgery. Neurosurg Focus 33(2):E5

  25. 25.

    Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–547

  26. 26.

    Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:1028–1035

  27. 27.

    Couldwell WT, Sabit I, Weiss MH, Giannotta SL, Rice D (1997) Transmaxillary approach to the anterior cavernous sinus: a microanatomic study. Neurosurgery 40:1307–1311

  28. 28.

    Kitano M, Taneda M (2001) Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 94:999–1004

  29. 29.

    Sabit I, Schaefer SD, Couldwell WT (2000) Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 110:286–291

  30. 30.

    Spencer WR, Das K, Nwagu C, Wenk E, Schaefer SD, Moscatello A, Couldwell WT (1999) Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope 109:791–794

  31. 31.

    Alfieri A (1999) Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation. J Neurosurg Sci 43:85–92

  32. 32.

    Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, Zanation A, Duz B, Stefko ST, Byers K, Horowitz MB (2011) Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg 114:1544–1568

  33. 33.

    Harvey RJ, Parmar P, Sacks R, Zanation AM (2012) Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 122:452–459

  34. 34.

    Bowers CA, Altay T, Couldwell WT (2011) Surgical decision-making strategies in tuberculum sellae meningioma resection. Neurosurg Focus 30(5):E1

  35. 35.

    Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2012) Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 77:713–724

Download references


We thank Kristin Kraus, MSc, our medical editor, for her contribution to manuscript editing; and Vance Mortimer, our video editor, for his contribution to editing operative videos.

Author information

Correspondence to William T. Couldwell.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1. Right fronto-orbital craniotomy for resection of trigeminal schwannoma. (MP4 26427 KB)

Video 1. Right fronto-orbital craniotomy for resection of trigeminal schwannoma. (MP4 26427 KB)

Video 2. Right trans-cochlear parapetrosal approach for excision of large sphenopetroclival meningioma. (MP4 25079 KB)

Video 2. Right trans-cochlear parapetrosal approach for excision of large sphenopetroclival meningioma. (MP4 25079 KB)

Video 3. Right far-lateral craniotomy for resection of foramen magnum meningioma. (MP4 26522 KB)

Video 3. Right far-lateral craniotomy for resection of foramen magnum meningioma. (MP4 26522 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Raheja, A., Couldwell, W.T. Microsurgical resection of skull base meningioma—expanding the operative corridor. J Neurooncol 130, 263–267 (2016).

Download citation


  • Skull base
  • Meningioma
  • Operative corridor
  • Technical nuances