111to the anterior petrous/Meckel’s cave tumors. We
are able to use the retrosigmoid approach with
additional petrous drilling to reach all these
tumors. Overall, they had excellent results with
most patients returning to full function and
achieved gross total resection in all 13 cases.
Functional preservation is one of the keys to
resection, with facial and hearing outcomes
being the most important for petrous face
tumors. The greatest experience reported in the
literature belongs to Majid Samii, who pre-
sented his experience with more than 400 CPA
meningiomas in two papers [ 12 , 15 ]. He used a
sitting suboccipital/retrosigmoid approach in
95% of cases and achieved Simpson Grade 1 or
2 resection in 86% of patients. The facial nerve
was preserved in 89% of cases, and hearing was
preserved in 91% of cases where the patient had
functional hearing preoperatively. In tumors
that invaded the IAC and required drilling of the
petrosal bone around the internal auditory
canal, facial nerve function was preserved in
80% of cases and hearing in 75% of cases.
Deveze et al. evaluated outcomes in 43 patients
with CPA meningiomas resected via a transpe-
trosal approach and found lower rates of gross
total resection (79%), facial nerve preservation
(73%), and hearing preservation (55%) [ 7 ].
Given these data, most modern surgeons use the
retrosigmoid approach when resecting petrous
face tumors. Baroncini et al. reported on 115Fig. 8.6 Large PPFM. Preoperative axial T1 post-contrast MRI showing a large PPFM that required a modified far
lateral approach
Fig. 8.7 Decompressed posterior fossa. Intraoperative
photograph from Case 4, the large PPFM, demonstrating
a relaxed cerebellum after CSF was released from the
upper cervical subarachnoid space
8 Meningiomas of the Cerebellopontine Angle