Combined Supra And Infratentorial Presigmoid Retrolabyrinthine Transpetrosal Approach For Resection Of Large Skull Base Meningiomas: A Technical Note

Abstract

Introduction: The approach consisting of a temporal–occipital craniotomy and posterior presigmoid retrolabyrinthine petrosectomy provides a wide corridor for the visualisation and resection of skull base tumors. This approach has been modified over the years to increase the extent of exposure while limiting the morbidity thereof. This paper aims to explain the versatility of this approach in resection of different anatomically located skull base tumors. Methods: We present two cases of patients with histologically confirmed skull base meningiomas resected via a combined presigmoid transpetrosal approach. The patients were positioned in the lateral position and a C Shaped incision was made around the pinna. Canal wall-up mastoidectomy and skeletonization of sigmoid sinus was done by the otolaryngology team prior to middle and posterior cranial fossa craniotomy. Dural opening of the middle and posterior fossa was done with ligation of the superior petrosal sinus. The tentorium was divided and the tumor was exposed after arachnoidal dissection with preservation of the neurovascular structures. The tumors were resected piecemeal to complete resection. No adverse sequelae were reported postoperatively. Results: The Combined Presigmoid transpetrosal Retrolabyrinthine Approach was effective in the complete resection of both petroclival and tentorial meningioma. Conclusion: The Combined Presigmoid transpetrosal retrolabyrnthine approach provides a suitable wide corridor for surgical resection of skull base tumors.