Combined subtemporal and retrosigmoid keyhole approach for extensive petroclival meningiomas surgery: Report of experience with 7 cases

Objective: The resection of petroclival meningiomas offers great challenges to the neurosurgeon. Surgery via a combined subtemporal and retrosigmoid keyhole approach surgery was evaluated for the treatment of extensive petroclival meningiomas on the basis of our experience with 7 cases. Methods: From July 2002 to July 2005, the resections of 7 petroclival meningiomas, which involved both supra- and infra-tentorial regions, were performed via a combined subtemporal and retrosigmoid keyhole approach. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results: The maximum diameter of tumors ranged from 3.4 to 6.0cm (mean: 4.4cm). Gross total resection (GTR) was achieved in 3 cases, giving a GTR rate of 43%. Subtotal resection (STR) was carried out in 4 cases. Neurological status remained intact in one case, while the others presented with cranial nerve deficits (VII, VI, V, III and lower CN). No death was reported during the postoperative period. Conclusion: This combined keyhole approach is suitable for the treatment of extensive petroclival meningiomas. It provides easy and quick access to the supra- and infratentorial juxta-clival regions without any petrous bone drilling. Complications related to the approach can be minimized.