title: Anterior Transpetrosal Approach Combined with Partial Posterior Petrosectomy for Petroclival Meningiomas with Posterior Extension.
abstract: BACKGROUND
  An anterior transpetrosal approach (ATPA) is suitable for treating upper petroclival lesions. However, the limit of the ATPA is reached when the tumor extends posterolaterally over the internal auditory canal (IAC) along the petrous edge. In such cases, ligation of the posterior part of the superior petrosal sinus (SPS) is necessary. To overcome this limitation, we combined the ATPA with a partial posterior petrosectomy in 8 patients who had petroclival meningiomas extending posterolaterally over the IAC.
  
  
  METHODS
  We resected only the Trautmann triangle in addition to the Kawase triangle to secure the space to ligate the posterior portion of the SPS. Because the tympanic cavity and bony labyrinth of the ear were not exposed, we were able to preserve hearing function and lower the risk of cerebrospinal fluid leakage. Furthermore, this approach enables easy ligation of the SPS and the tentorium posterior to the tumor attachment. This combined technique also allows visualization of the petrosal vein, which is important for surgery of the posterior fossa.
  
  
  RESULTS
  Total and near-total tumor removal was achieved in 6 patients (75%) with no permanent complications and no cerebrospinal fluid leakage. Postoperative hearing impairment was not found in any of the patients who underwent this surgery.
  
  
  CONCLUSIONS
  The ATPA combined with partial posterior petrosectomy is an effective method for removal of complicated petroclival meningiomas that extend posterolaterally over the IAC along the petrous edge.
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku, Tokyo, Japan. Electronic address: pochisuke616@mac.com.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Shibao
authors.affiliation: Department of Neurosurgey, Clemens Hospital, Münster University, Münster, Germany.
authors.forename: Hamid
authors.initials: H
authors.lastname: Borghei-Razavi
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku, Tokyo, Japan.
authors.forename: Maaya
authors.initials: M
authors.lastname: Orii
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku, Tokyo, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D007758:Ear, Inner / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000473:pathology* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D061646:Operative Time; D010579:Petrous Bone / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology
keywords: Anterior transpetrosal approach; Petroclival meningioma; Petrosal vein; Superior petrosal sinus; Trautmann triangle