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Combined transpetrosal approach for giant petroclival meningioma: 2-dimensional operative video

Vera Vigo, Karam Asmaro, Maximiliano A. Nuñez, Ahmed Moyheldin, Robert K. Jackler, and Juan C. Fernandez-Miranda

Petroclival meningiomas are extremally challenging lesions due to their deep location and close relation to critical neurovascular structures. Several approaches have been described to achieve gross-total resection with low morbidity and mortality. In this 2-dimensional operative video, the authors show a simultaneous combined transpetrosal approach. The patient is a 44-year-old woman with an 8-month history of gait imbalance with evidence of a giant petroclival meningioma on neuroimaging. She underwent a combined middle fossa approach with anterior petrosectomy and retrosigmoid/retrolabyrinthine approach to achieve gross-total tumor resection. The postoperative course was characterized by trigeminal neuralgia, and neuroimaging showed gross-total resection of the tumor.

The video can be found here:

Open access

Introduction. Vestibular schwannoma surgery

Michael J. Link, Isaac Yang, Fred G. Barker II, Amir Samii, and Philip V. Theodosopoulos

dealing with VS and rare secondary effects such as hemifacial spasm and trigeminal neuralgia are included. Techniques to deal with cystic tumors, giant tumors, and aberrant anatomy such as a high jugular bulb, making the operation even more difficult, are reviewed. Surgical adjuvants such as the use of endoscopes are also highlighted. Finally, strategies to help deal with tumors related to neurofibromatosis type 2 are included, and hearing rehabilitation options with cochlear implants or auditory brainstem implants are discussed. While some aspects of the operations

Open access

Feasibility of exoscopic keyhole surgery: case series

Miguel Sáez-Alegre, Christian Ríos-Vicil, Keaton Piper, Edinson Najera, and Walter C. Jean

right trigeminal neuralgia refractory both to GKS and medication. The FIESTA MRI sequence showed a loop of the SCA touching the right trigeminal nerve. An MVD through a retrosigmoid craniotomy was performed. In the video, we can see the trigeminal nerve completely thinned, probably due to chronic compression plus GKS. Carefully, the nerve was separated from the SCA loop and a Teflon was placed between these two structures. Patient remains pain free 1 year postoperative on medication. 6:04 The last patient is a 60-year-old female with a left petrous meningioma