Skull Base Surgery of the Posterior Fossa

117

Case 4: Combined Transpetrosal
Approach (Fig. 9.5)
A 39-year-old man presented with a 2-month
history of gait disturbance. MR imaging showed
a large mass lesion at the right tentorial incisura.
The tumor severely compressed the brain stem
and medial temporal lobe. Resection of the tumor
was performed via a combined transpetrosal
approach. The tumor adhered tightly to the mid-
brain at the interpeduncular cistern, leaving a
small residual amount of tumor along the right

oculomotor nerve. Subtotal resection of the

tumor was performed with transient right oculo-

motor nerve palsy and left hemiparesis. These

symptoms improved completely within 3 months.

Falcotentorial Type

Meningiomas arising from the falcotentorial

junction are relatively rare, and only isolated case

reports or small series related to surgical

Fig. 9.2 Case 1. Preoperative axial (a) and coronal (b)
T1-weighted magnetic resonance images with gadolinium
showing the left incisural type of tentorial meningioma.

Postoperative axial (c) and coronal (d) T1-weighted mag-

netic resonance images with gadolinium showing no

tumor residual via a retrosigmoid approach

9 Tentorial Meningiomas