Combined subtemporal and retrosigmoid keyhole approach for extensive petroclival meningioma surgery: report of experience with 7 cases.
OBJECTIVE
Resection of petroclival meningiomas offers great challenges to the neurosurgeons. Our experience of 7 cases using a combined subtemporal and retrosigmoid keyhole approach surgery was evaluated for the treatment of extensive petroclival meningiomas.


METHODS
From July 2002 to July 2005, resections of 7 petroclival meningiomas, which involved both supra- and infratentorial 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 the tumors ranged from 3.4 to 6.0 cm (mean: 4.4 cm). 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 others presented with cranial nerve deficits (VII, VI, V, III and lower CN). No death was reported in the cases during the postoperative period.


CONCLUSIONS
The combined keyhole approach is suitable for the treatment of extensive petroclival meningiomas. It provides easy and quick access to the supra- and infratentorial juxtaclival region without any petrous bone drilling. Complications related to the approach can be minimized.
Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
W
W
Zhu
Y
Y
Mao
L-F
LF
Zhou
R
R
Zhang
L
L
Chen
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002426:Cavernous Sinus / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D003391:Cranial Nerves / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D016896:Treatment Outcome