title: Endoscopic-Assisted Posterior Intradural Petrous Apicectomy in Petroclival Meningiomas: A Clinical Series and Assessment of Perioperative Morbidity.
abstract: OBJECTIVE
  To describe the clinical feasibility and outcome of the endoscopic-assisted posterior intradural petrous apicectomy approach (PIPA) for petroclival meningiomas extending into the supratentorial space.
  
  
  METHODS
  From 2005-2013, 29 patients with a petroclival meningioma underwent tumor removal through a PIPA approach. The approach consists of a retrosigmoid approach, intradural anterior resection of the petrous apex and microsurgical removal of the tumor, followed by endoscopic-assisted visualization and removal of tumor parts in the middle fossa or anterior to the brainstem.
  
  
  RESULTS
  Patients consisted of 7 men and 22 women; the mean age of patients was 52.7 years. In 24 patients, surgery was performed with the patient in a semisitting position; in 5 patients, surgery was performed with the patient in a supine position. A total resection was achieved in 19 patients (66%). A Karnofsky performance scale score >60% was recorded in 27 patients (93%), with surgical complications that involved a cerebrospinal fluid leak in 3 patients, bleeding in the surgical cavity in 2 patients, and pneumocephalus in 1 patient. The most frequent postoperative neurologic deficit was facial palsy (34%), which disappeared or improved consistently in all but 1 patient, who required a cranial nerve VII-cranial nerve XII anastomosis.
  
  
  CONCLUSIONS
  For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. The principal advantages of the PIPA approach are familiarity with the retrosigmoid route; the absence of temporal lobe retraction; and early control of the cranial nerves, vessels, and brainstem. However, careful patient selection regarding tumor extension is fundamental to obtaining optimal outcomes.
authors.affiliation: Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
authors.affiliation: Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigante
authors.affiliation: Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany.
authors.forename: Paulo
authors.initials: P
authors.lastname: Mesquita Filho
authors.affiliation: Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany.
authors.forename: Florian H
authors.initials: FH
authors.lastname: Ebner
authors.affiliation: Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany; Department of Neurosurgery, Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates. Electronic address: roserf@clevelandclinicabudhabi.ae.
authors.forename: Florian
authors.initials: F
authors.lastname: Roser
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D059035:Perioperative Period; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopy; Meningioma; Petroclival; Retrosigmoid; Skull base; Subtemporal