CC BY-NC-ND 4.0 · J Neurol Surg B 2019; 80(S 03): S290-S291
DOI: 10.1055/s-0039-1685532
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Retrosigmoid Suprameatal Approach for Resection of Petrotentorial Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances

James K. Liu
1  Department of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
,
Vincent N. Dodson
1  Department of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
› Author Affiliations
Further Information

Address for correspondence

James K. Liu, MD
Department of Neurological Surgery, Rutgers University, New Jersey Medical School
90 Bergen Street, Suite 8100, Newark, New Jersey 07103
United States   

Publication History

05 March 2019

06 March 2019

Publication Date:
22 April 2019 (online)

 

    Abstract

    Meningiomas are the second most common tumor to arise in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petrotentorial meningioma in the cerebellopontine angle via a retrosigmoid suprameatal approach. Drilling of the hyperostotic suprameatal tubercle was necessary to gain access to the dural origin and anterior petrosal extent of the tumor. The nuances of microsurgical and skull base technique are illustrated including microsurgical dissection of the tumor away from the brainstem and neurovascular structures, facial nerve preservation, and fat graft-assisted Medpor Titan reconstruction to prevent cerebrospinal fluid leakage. A gross total resection was achieved, and the patient was neurologically intact. In summary, the retrosigmoid suprameatal approach is an important strategy in the armamentarium for surgical management of petrotentorial meningiomas in the cerebellopontine angle.

    The link to the video can be found at: https://youtu.be/kwQP6BSYK7U.


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    Zoom Image
    Fig. 1 Preoperative post-gadolinium T1-weighted MRI (a, axial view; b, coronal view) demonstrates left petrotentorial meningioma with brainstem compression. Postoperative MRI at 3 months (c, axial view; d, coronal view) shows no recurrence or residual tumor.
    Zoom Image
    Fig. 2 (a) Intraoperative photograph showing drilling of the suprameatal tubercle to gain access to the anterior petrosal portion of the tumor. (b) View of resection bed exposing cranial nerves V to VIII.

    www.thieme.com/skullbasevideos

    www.thieme.com/jnlsbvideos


    Quality:

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    Conflict of Interest

    None declared.

    Address for correspondence

    James K. Liu, MD
    Department of Neurological Surgery, Rutgers University, New Jersey Medical School
    90 Bergen Street, Suite 8100, Newark, New Jersey 07103
    United States   

      
    Zoom Image
    Fig. 1 Preoperative post-gadolinium T1-weighted MRI (a, axial view; b, coronal view) demonstrates left petrotentorial meningioma with brainstem compression. Postoperative MRI at 3 months (c, axial view; d, coronal view) shows no recurrence or residual tumor.
    Zoom Image
    Fig. 2 (a) Intraoperative photograph showing drilling of the suprameatal tubercle to gain access to the anterior petrosal portion of the tumor. (b) View of resection bed exposing cranial nerves V to VIII.