Abstract
Background Anterior transpetrosal approach and the combined transpetrosal approach are the major
surgical approaches for petroclival meningiomas. However, anterior petrosectomy is
not preferable in cases with postoperative venous drainage disorder of the sylvian
vein due to anatomical variations. Here we present a case of the successful removal
of petroclival meningioma by the retrosigmoid intradural suprameatal approach (RISA).
Case Presentation The patient was a 59-year-old woman with incidentally detected right petroclival
meningioma. Although she had no neurological deficit, the tumor manifested with gradual
growth on annual magnetic resonance imaging (MRI) during an 8-year follow-up. Three-dimensional
computed tomography venography (3D–CTV) revealed sphenobasal type of the sylvian vein
throughout the lateral side of the foramen ovale. Because the suprameatal tubercle
was an obstacle to observe the Meckel's cave, RISA was selected for complete tumor
excision. RISA could provide an excellent operative field around the Meckel's cave
to confirm the remnant tumor. Postoperative MRI showed no evidence of the tumor, and
the patient was discharged without any neurological deficit.
Conclusion RISA can provide a favorable operative field for petroclival meningioma, particularly
for cases with high risk of postoperative complications related to the sylvian vein.
The link to the video can be found at: https://youtu.be/cfci_zk0StU.
Keywords
petroclival meningioma - retrosigmoid approach - retrosigmoid intradural suprameatal
approach - suprameatal tubercle - anterior transpetrosal approach - sphenobasal vein
- sylvian vein
