Skull Base Surgery of the Posterior Fossa

62

Conclusion

The posterior petrosal and combined petrosal
approaches are important neurosurgical routes
that provide excellent access to lesions in the
petroclival region, spanning the middle and
lower clivus, petrous apex, cavernous sinus, and
Meckel’s cave. The approaches provide gener-
ous access while preserving function (including
hearing) and allowing for multiple angles of
attack for tumor resection and neurovascular
preservation.

References

1. Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura
   T. Clivus meningioma: six cases of total removal.
   Neurol Med Chir (Tokyo). The Japan Neurosurgical
   Society. 1977;17(1):63–77.


2. Gross BA, Tavanaiepour D, Du R, Al-Mefty O, Dunn
   IF. Evolution of the posterior petrosal approach.
   Neurosurg Focus. 2012;33(2):E7.


3. Al-Mefty O, Fox JL, Smith RR. Petrosal approach
   for petroclival meningiomas. Neurosurgery. LWW.
   1988;22(3):510–7.


4. Al-Mefty O, Ayoubi S, Smith RR. The petrosal
   approach: indications, technique, and results. In: Acta

Fig. 4.6 3D reconstruction using segmentation of brain
MRI for a patient who underwent a combined petrosal
approach for resection of a petroclival meningioma. (a) A
full 3D reconstruction prior to the craniotomy showing
the location of the dural sinuses (blue), tumor (green), and
the arterial system (red). (b) 3D reconstruction following
the combined supratentorial and infratentorial craniotomy
and mastoidectomy with the head in the surgical position.
Tumor (green) presence in the posterior and middle cra-
nial fossae is well demonstrated. Presigmoid (blue) access
to the tumor is limited. The tentorium (brown) and the

arterial vasculature (red) are also shown. (c) 3D recon-

struction after the tentorium (brown) has been cut allow-

ing the sinus (blue) to be mobilized. The maneuver allows

full access to the tumor (green) without the need for

retraction. The arterial vasculature (red) is also shown. (d)

Volumetric 3D reconstruction of the tumor (green), dural

venous sinuses (blue), and the arterial vasculature (red) is

shown with the three orthogonal MRI planes in order to

demonstrate their relationship to the surrounding brain

parenchyma

D. Aum et al.