title: Combined transpetrosal and fronto-orbito-zygomatic approach to a giant skull based meningioma: a case report.
abstract: BACKGROUND
  Recently, various surgical approaches to skull base lesions have been developed. Skillful use of the combination of two standard approaches make possible the removal of large brain lesions, which conventionally had been considered inoperative. In this study, we present a case of a giant meningioma located in the cerebellopontine angle and middle cranial fossa. A near total resection was achieved using a combined transpetrosal and fronto-orbito-zygomatic approach.
  
  
  METHODS
  A 15-year-old boy presented with a meningioma that caused a left hearing loss, dysarthria, and cerebellar ataxia. Preoperative magnetic resonance imaging revealed a giant meningioma located in the right cerebellopontine angle, middle fossa, and cavernous sinus. The patient underwent a near total resection of the tumor through a combined transpetrosal and fronto-orbito-zygomatic approach. He experienced a marked improvement postoperatively and entered high school the following year.
  
  
  CONCLUSIONS
  An approach from several angles was necessary for the giant skull based tumor presented here. A combination approach was selected for obtaining a wide operative field with minimal brain compression during resection of neoplasm. According to the individual features of each case, selection of the operative approach, decisions regarding the extent of excision, and postoperative treatment regimens should be adequately planned in the preoperative period.
authors.affiliation: Department of Neurosurgery, Kobe University School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Eguchi
authors.forename: N
authors.initials: N
authors.lastname: Tamaki
authors.forename: H
authors.initials: H
authors.lastname: Kurata
authors.forename: T
authors.initials: T
authors.lastname: Nagashima
authors.forename: A
authors.initials: A
authors.lastname: Fujita
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: Y
authors.initials: Y
authors.lastname: Hara
mesh_terms: D000293:Adolescent; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D019291:Skull Base / Q000601:surgery