Total Petrosectomy for the Total Resection of Sphenopetroclival Meningioma: 2-Dimensional Operative Video.

Sphenopetroclival meningioma is a most formidable meningioma. Many patients have few preoperative deficits and surgery has the potential of severe neurological complications. Surgical treatment is challenging due to brainstem compression, the involvement of multiple cranial nerves and cerebral vessels. Wide tumor exposure, multiple dissection axis, and short distance are paramount factors in the quest of achieving total removal of Simpson grade I, including the involved dura and bone. The posterior petrosal, transtentorial presigmoid approach offers a wide and shallow operative field.1-7 When the patient has hearing loss, extending the resection of the temporal bone provides unmatchable exposure facilitating safer and more complete tumor removal. This article demonstrates the removal of a sphenopetroclival meningioma through total petrosectomy with closing of the external auditory canal and preservation of the facial nerve in the Fallopian canal. A total resection of the tumor was achieved with long-term preservation of cranial nerve function. The surgical steps of total petrosectomy are shown, including the skin flap, combined middle and posterior fossa craniotomy, skeletonization of the sigmoid transverse sinus, radical mastoidectomy, dissection of the Fallopian canal, and drilling of the labyrinth, cochlea, and petrous apex for superb exposure.8 We demonstrate the intra-arachnoidal microsurgical dissection utilized for the radical resection of petroclival meningioma. This surgery performed in 1995 is a testament to the time-tested technique. The patient consented to the procedure and image use. Images at 1:33 and 3:57 © Ossama Al-Mefty, used with permission.