title: Detailed anatomy knowledge: first step to approach petroclival meningiomas through the petrous apex. Anatomy lab experience and surgical series.
abstract: Petroclival meningiomas are a challenge for neurosurgeons due to the complex anatomy of the region that is rich of vessels and nerves. A perfect and detailed knowledge of the anatomy is very demanding in neurosurgery, especially in skull base surgery. The authors describe the microsurgical anatomy to perform an anterior petrosectomy based on their anatomical and surgical experience and perform a literature review. The temporal bone is the most complex and fascinating bone of skull base. The apex is located in the angle between the greater wing of the sphenoid and the occipital bone. Removing the petrous apex exposes the clivus. The approach directed through the temporal bone in this anatomical area is referred to as an anterior petrosectomy. The area that must be drilled is the rhomboid fossa that is defined by the Kawase, premeatal, and postmeatal triangles. In Division of Neurosurgery - University of Turin, 130 patients, from August 2013 to September 2015, underwent surgical resection of intracranial meningiomas. In this group, we have operated 7 PCMs and 5 of these were approached performing an anterior petrosectomy with good results. In our conclusions, we feel that this surgery require an advanced knowledge of human anatomy and a specialized training in interpretation of radiological and microsurgical anatomy both in the dissection lab and in the operating room.
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy. roberto.altieri.87@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Altieri
authors.affiliation: Department of Neurosurgery, Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sameshima
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pacca
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Crobeddu
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Garbossa
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ducati
authors.affiliation: Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zenga
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002102:Cadaver; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008866:Microsurgery; D010579:Petrous Bone / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Anterior petrosectomy; Petroclival meningiomas; Petrous apex; Rhomboid fossa; Skullbase anatomy