Retrosigmoid-transtentorial approach for petroclival meningiomas: operative technique and clinical outcome

Abstract

Background: Petroclival meningiomas (PCMs) are technically challenging lesions. Although the standard retrosigmoid approach is one of the most effective approaches, this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa. We provide a modified surgical technique called retrosigmoid-transtentorial approach (RTTA) to solve these problems. The feasibility and efficacy of the RTTA were studied, by analyzing neurological outcomes and considerations of surgical strategies. Methods: We analyzed 64 of 71 PCM patients (90.1 %). All 64 patients had epicenter of tumor in the posterior fossa with varying degrees of extension into the supratentorial area and/or the middle fossa. A conventional retrosigmoid craniotomy was performed following which the tentorium was incised from the attachment of tumor toward the free edge, which improved exposure to the petroclival region by offering additional operative room without resection of the adjacent part of the petrous bone. Results: The rate of gross total resection was 71.9 %. There was no incidence of intraoperative death. One patient died in the postoperative phase. The postoperative permanent morbidity rate was 25.4 %. Follow-up was done with the mean time of 60.7 ± 47.5 months. There were 6 recurrence, 8 progression and 7 death cases and the mean KPS score was 83.2 ± 13.4 in the last follow up. Conclusions: The RTTA achieves the goal of applying a safe, quick, uncomplicated, and lesser invasive access to the petroclival region which is indicated for tumors located in the posterior fossa with some extension into the supratentorial area and/or the middle fossa.

Treatment Strategy for Petroclival Meningiomas Based on a Proposed Classification in a Study of 168 Cases

“…www.nature.com/scientificreports www.nature.com/scientificreports/ exposure to the petroclival region by adding operative intervals to resect supratentorial lesions 18 . The RTTA was considered as an excellent approach to reach the ventrolateral brainstem and the petroclival region for providing a better superoventral exposure of the ventrolateral brainstem than BRSA 19 verified our opinion and choice.…”

The 100 Most Highly Cited Publications on Hearing Preservation for Vestibular Schwannomas

“…Records date the inception of the retrosigmoid-originally termed as "suboccipital"-approach to the early 1900s. 57 This approach has been modified throughout the years and remains the main route to access the posterior fossa and cerebellopontine angle. [58][59][60] The papers most cited per year within surgical treatment include 4 papers by Samii et al [42][43][44]46 and 1 paper by Pollock et al 56 The suboccipital transmeatal, retrosigmoid, middle fossa, and translabyrinthine approaches were demonstrated.…”