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Surgical Neurology International
Editor-in-Chief: Nancy E. Epstein, MD, Clinical Professor of Neurological Surgery, School of
Medicine, State U. of NY at Stony Brook.
SNI: Skull Base Editor
Mitsutoshi Nakada, MD
Kanazawa University, Ishikawa, Japan
Open Access
Video Abstract
Posterior petrosal approach for microsurgical resection
of petroclival meningioma: 3-Dimensional operative
video
Guilherme Henrique Weiler Ceccato1, Rodolfo Frank Munhoz da Rocha2, Anderson Matsubara1, Luis Alencar Biurrum Borba1
Department of Neurosurgery, Mackenzie Evangelical University Hospital, 2School of Medicine, Mackenzie Evangelical College of Paraná, Curitiba, Paraná,
1
Brazil.
E-mail: Guilherme Henrique Weiler Ceccato - [email protected]; Rodolfo Frank Munhoz da Rocha - [email protected]; Anderson
Matsubara - [email protected]; *Luis Alencar Biurrum Borba - [email protected]
ABSTRACT
Background: Petroclival meningiomas are challenging lesions considering their deep location and close
relationship with many vital neurovascular structures.[1-8]
Case Description: We present the case of a 54-year-old male presenting a history of headache, dizziness, and
tinnitus on the left side, associated with left facial hypoesthesia. Preoperative imaging depicted a lesion highly
*Corresponding author: suggestive of a petroclival meningioma with important compression of the brainstem. Considering worsening
Luis Alencar Biurrum Borba, of symptoms, size, and location of this lesion, microsurgical resection was indicated. A left posterior petrosal
Department of Neurosurgery, approach was employed with aid of neurophysiological monitoring. The patient was placed in a true lateral
Mackenzie Evangelical position and an arciform incision was done. First, the mastoidectomy was performed and then the craniotomy
University Hospital, Curitiba, around encompassing both posterior and middle cranial fossae. Middle and posterior fossa dural incisions were
Paraná, Brazil. connected through coagulation of the superior petrosal sinus. Then tentorium was all the way cut to the incisura.
After that, sigmoid sinus can be mobilized posteriorly, increasing exposure of presigmoid space. The area since
[email protected] jugular foramen up to the supratentorial region was fully exposed, allowing safe total resection of the lesion.
Postoperative imaging demonstrated complete tumor removal. Patient presented improvement of symptoms, with
Received : 15 March 2021 no new neurological deficits on follow-up.
Accepted : 25 May 2021 Conclusion: The posterior petrosal approach provided a shorter pathway and direct angle of attack to the tumor
Published : 06 July 2021 attachment, allowing successful resection.[1,6] Extensive laboratory training is essential to get familiarized with the
complex anatomical relationships in that area. Informed consent was obtained from the patient for the procedure
DOI and publication of this operative video.
10.25259/SNI_270_2021
Keywords: Meningioma, Petroclival, Posterior petrosal, Skull base, Tumor
Quick Response Code:
[Video 1]-Available on:
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Annotations[1-8]
1) 0:07 - Clinical Presentation
2) 0:21 - Neuro-imaging Findings
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©2021 Published by Scientific Scholar on behalf of Surgical Neurology International
Surgical Neurology International • 2021 • 12(324) | 1
Ceccato, et al.: Posterior petrosal approach microsurgical resection petroclival meningioma
3) 0:59 - Tumor 3D Model management. J Neurosurg 2014;120:40-51.
4) 1:11 - Rationale for the Procedure 2. Coppens JR, Couldwell WT. Clival and petroclival
5) 1:33 - Approach 3D Model meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O,
6) 2:25 - Risks of the Procedure and its Potential Benefits editors. Al-Mefty’s Meningiomas. 2nd ed. New York: Thieme
Medical Publishers; 2011. p. 270-82.
7) 2:30 - Alternatives and Why They Were not Chosen
3. DiLuna ML, Bulsara KR. Surgery for petroclival meningiomas:
8) 2:36 - Anatomy
A comprehensive review of outcomes in the skull base surgery
9) 4:27 - Description of the Setup era. Skull Base 2010;20:337-42.
10) 4:34 - Procedure 4. Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M,
11) 8:37 - Disease Background Meling TR, et al. Petroclival meningiomas: Update of current
12) 8:44 - Postoperative Imaging treatment and consensus by the EANS skull base section. Acta
13) 9:24 - Outcome Neurochir (Wien) 2021;163:1639-63.
5. Gosal JS, Behari S, Joseph J, Jaiswal AK, Sardhara JC,
Declaration of patient consent Iqbal M, et al. Surgical excision of large-to-giant petroclival
meningiomas focusing on the middle fossa approaches: The
The authors certify that they have obtained all appropriate lessons learnt. Neurol India 2018;66:1434-46.
patient consent. 6. Havenbergh TV, Carvalho G, Tatagiba M, Plets C, Samii M.
Natural history of petroclival meningiomas. Neurosurgery
2003;52:55-62.
Financial support and sponsorship
7. Hunter JB, Yawn RJ, Wang R, O’Connell BP, Carlson ML,
Nil. Mistry A, et al. The natural history of petroclival meningiomas:
A volumetric study. Otol Neurotol 2017;38:123-8.
8. Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and
Conflicts of interest
growth rate of subtotally resected petroclival meningiomas:
There are no conflicts of interest. Experience with 38 cases. Neurosurgery 2000;46:567-74.
REFERENCES How to cite this article: Ceccato GH, da Rocha RF, Matsubara A,
Borba LA. Posterior petrosal approach for microsurgical resection of
1. Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al- petroclival meningioma: 3-Dimensional operative video. Surg Neurol Int
2021;12:324.
Mefty O. True petroclival meningiomas: Results of surgical
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