title: Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach.
abstract: The authors describe a modified anterior transpetrous approach (ATPA) for the surgical resection of 21 cases of petroclival meningiomas (PCMs). Briefly, a curved periauricular skin incision was used. The cerebellar tentorium and the dura on the petrous apex were coagulated and incised to expose the petrous apex bone fully. The drilling of the petrous apex bone was performed subdurally and began internally from the trigeminal impression, not exceeding 1.5 cm laterally, not exceeding 6 mm from the posterior edge of the petrous ridge, and not exceeding 8 mm in depth from the surface of the petrous bone. The tumors were removed totally in 12 (57.1%) cases, subtotally in 8 (38.1%) cases, and partially in 1 (4.8%) case. The transient neurological deficit includes mild oculomotor nerve palsy in three cases, abducens nerve palsy in six cases, language disorder in three cases, and mild hemiplegia in two cases. Facial numbness became worse postoperatively in six patients, and only two patients improved at 6 months after surgery. No death occurred in this series. The modified ATPA is an efficient treatment alterative for large or giant PCMs located at the medial and superior internal acoustic meatus with relatively low risk of complications.
authors.affiliation: Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University, No.6, Tiantan Xili, Dongcheng District, Beijing, 100050, China, xrttyy2013@163.com.
authors.forename: Xinru
authors.initials: X
authors.lastname: Xiao
authors.forename: Liwei
authors.initials: L
authors.lastname: Zhang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wu
authors.forename: Junting
authors.initials: J
authors.lastname: Zhang
authors.forename: Guijun
authors.initials: G
authors.lastname: Jia
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.forename: Guolu
authors.initials: G
authors.lastname: Meng
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D020209:Cranial Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010579:Petrous Bone / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome