Objective: Meningiomas arising from the cavernous sinus (CS) continue to be a significant technical
challenge, and resection continues to carry a relatively higher risk of neurological
morbidity in patients with these lesions because of the tumor's proximity to neurovascular
structures. The authors report the surgical outcomes of 9 patients with primary CS
meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior
combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.
Methods: This retrospective study included nine patients who underwent surgery for CSM treatment
for the last 2 years via the MAPC transpetrosal approach. Two patients were men and
7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had
undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital
craniotomy and exposure of the posterolateral part of the CS via the presigmoid MAPC
approach. After opening Meckel's cave and identifying the 3rd-5th cranial nerves in
the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened.
Finally, the tumor occupying the posterolateral part of the CS was removed.
Results: All lesions were safely and maximally removed, with preservation of external ocular
movements and preoperative Karnofsky Performance Scale scores. The mean extent of
resection was 77.0% (range: 58.7–95.4%). Six patients underwent adjuvant therapy in
the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during
the follow-up period; none of these patients experienced recurrence.
Conclusion: The authors conclude that the MAPC transpetrosal approach could be superior to other
approaches for CSMs, as it provides direct visual access to the posterolateral portion
of the CS. In their experience, this approach is an alternative and better option
for safe maximal resection of CSMs.
