Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

View More View Less
  • 1 Department of Neurosurgery, Hannover Medical School and Nordstadt Hospital, Hannover, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA).

Methods. The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa.

Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients.

Conclusions. Theapproach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Madjid Samii, M.D., Neurochirurgische Kliniken, Medizinische Hochschule Hannover und Klinikum Hannover Nordstadt, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. email: neurosurgery.nordstadt@metronet.de.
  • 1.

    Al-Mefty O, , Ayoubi S, & Smith RR: The petrosal approach: indications, technique, and results. Acta Neurochir Suppl 53:166170, 1991 Al-Mefty O, Ayoubi S, Smith RR: The petrosal approach: indications, technique, and results. Acta Neurochir Suppl 53:166–170, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Al-Mefty O, , Fox JL, & Smith RR: Petrosal approach for petroclival meningiomas. Neurosurgery 22:510517, 1988 Al-Mefty O, Fox JL, Smith RR: Petrosal approach for petroclival meningiomas. Neurosurgery 22:510–517, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Bricolo AP, , Turazzi S, & Talacchi A, et al: Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31:813828, 1992 Bricolo AP, Turazzi S, Talacchi A, et al: Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery 31:813–828, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Cantore G, , Delfini R, & Ciappetta P: Surgical treatment of petroclival meningiomas: experience with 16 cases. Surg Neurol 42:105111, 1994 Cantore G, Delfini R, Ciappetta P: Surgical treatment of petroclival meningiomas: experience with 16 cases. Surg Neurol 42:105–111, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Cheung SW, , Jackler RK, & Pitts LH, et al: Interconnecting the posterior and middle cranial fossae for tumors that traverse Meckel's cave. Am J Otol 16:200208, 1995 Cheung SW, Jackler RK, Pitts LH, et al: Interconnecting the posterior and middle cranial fossae for tumors that traverse Meckel's cave. Am J Otol 16:200–208, 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Hakuba A: The transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas, in Samii M (ed): Surgery in and Around the Brain Stem and the Third Ventricle. Anatomy, Pathology, Neurophysiology, Diagnosis, Treatment. Berlin: Springer-Verlag, 1986, pp 396402 Hakuba A: The transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas, in Samii M (ed): Surgery in and Around the Brain Stem and the Third Ventricle. Anatomy, Pathology, Neurophysiology, Diagnosis, Treatment. Berlin: Springer-Verlag, 1986, pp 396–402

    • Search Google Scholar
    • Export Citation
  • 7.

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146147, 1985 House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147, 1985

    • Search Google Scholar
    • Export Citation
  • 8.

    Kawase T, , Shiobara R, & Toya S: Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869876, 1991 Kawase T, Shiobara R, Toya S: Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869–876, 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Kawase T, , Toya S, & Shiobara R, et al: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857861, 1985 Kawase T, Toya S, Shiobara R, et al: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857–861, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Lang J: Clinical Anatomy of the Posterior Cranial Fossa and its Foramina. Stuttgart: Thieme, 1991 Lang J: Clinical Anatomy of the Posterior Cranial Fossa and its Foramina. Stuttgart: Thieme, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Miller CG, , van Loveren H, & Keller JT, et al: Transpetrosal approach: surgical anatomy and technique. Neurosurgery 33:461469, 1993 Miller CG, van Loveren H, Keller JT, et al: Transpetrosal approach: surgical anatomy and technique. Neurosurgery 33:461–469, 1993

    • Search Google Scholar
    • Export Citation
  • 12.

    Morrison AW, & King TT: Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. Technical note. J Neurosurg 38:382390, 1973 Morrison AW, King TT: Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. Technical note. J Neurosurg 38:382–390, 1973

    • Search Google Scholar
    • Export Citation
  • 13.

    Samii M, & Ammirati M: The combined supra-infratentorial presigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir 95:612, 1988 Samii M, Ammirati M: The combined supra-infratentorial presigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir 95:6–12, 1988

    • Search Google Scholar
    • Export Citation
  • 14.

    Samii M, , Ammirati M, & Mahran A, et al: Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24:1217, 1989 Samii M, Ammirati M, Mahran A, et al: Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24:12–17, 1989

    • Search Google Scholar
    • Export Citation
  • 15.

    Samii M, , Carvalho GA, & Tatagiba M, et al: Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 41:767775, 1997 Samii M, Carvalho GA, Tatagiba M, et al: Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 41:767–775, 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Samii M, , Migliori MM, & Tatagiba M, et al: Surgical treatment of trigeminal schwannomas. J Neurosurg 82:711718, 1995 Samii M, Migliori MM, Tatagiba M, et al: Surgical treatment of trigeminal schwannomas. J Neurosurg 82:711–718, 1995

    • Search Google Scholar
    • Export Citation
  • 17.

    Samii M, & Tatagiba M: Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir 118:2732, 1992 Samii M, Tatagiba M: Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir 118:27–32, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Samii M, & Tatagiba M: Neurosurgical aspects of tumors of the base of the skull, in Youmans JR (ed): Neurological Surgery, ed 4. Philadelphia: WB Saunders, 1996, pp 30243040 Samii M, Tatagiba M: Neurosurgical aspects of tumors of the base of the skull, in Youmans JR (ed): Neurological Surgery, ed 4. Philadelphia: WB Saunders, 1996, pp 3024–3040

    • Search Google Scholar
    • Export Citation
  • 19.

    Samii M, , Tatagiba M, & Carvalho GA: Resection of large petroclival meningiomas by the simple retrosigmoid route. J Neurosurg Sci 6:2730, 1999 Samii M, Tatagiba M, Carvalho GA: Resection of large petroclival meningiomas by the simple retrosigmoid route. J Neurosurg Sci 6:27–30, 1999

    • Search Google Scholar
    • Export Citation
  • 20.

    Samii M, , Tatagiba M, & Piquer J, et al: Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 84:1419, 1996 Samii M, Tatagiba M, Piquer J, et al: Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 84:14–19, 1996

    • Search Google Scholar
    • Export Citation
  • 21.

    Sanna M, , Mazzoni A, & Saleh EA, et al: Lateral approaches to the median skull base through the petrous bone: the system of the modified transcochlear approach. J Laryngol Otol 108:10361044, 1994 Sanna M, Mazzoni A, Saleh EA, et al: Lateral approaches to the median skull base through the petrous bone: the system of the modified transcochlear approach. J Laryngol Otol 108:1036–1044, 1994

    • Search Google Scholar
    • Export Citation
  • 22.

    Sekhar LN, , Pomeranz S, & Sen CN: Extradural petrous bone and petroclival neoplasms. Acta Neurochir Suppl 53:183192, 1991 Sekhar LN, Pomeranz S, Sen CN: Extradural petrous bone and petroclival neoplasms. Acta Neurochir Suppl 53:183–192, 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    Seoane E, & Rhoton AL Jr: Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery 44:553560, 1999 Seoane E, Rhoton AL Jr: Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery 44:553–560, 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:2239, 1957 Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39, 1957

    • Search Google Scholar
    • Export Citation
  • 25.

    Spetzler RF, , Hamilton MG, & Daspit CP: Petroclival lesions. Clin Neurosurg 41:6282, 1994 Spetzler RF, Hamilton MG, Daspit CP: Petroclival lesions. Clin Neurosurg 41:62–82, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Tatagiba M, , Samii M, & Matthies C, et al: Management of petroclival meningiomas: a critical analysis of surgical treatment. Acta Neurochir Suppl 65:9294, 1996 Tatagiba M, Samii M, Matthies C, et al: Management of petroclival meningiomas: a critical analysis of surgical treatment. Acta Neurochir Suppl 65:92–94, 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Tedeschi H, & Rhoton AL Jr: Lateral approaches to the petroclival region. Surg Neurol 41:180216, 1994 Tedeschi H, Rhoton AL Jr: Lateral approaches to the petroclival region. Surg Neurol 41:180–216, 1994

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 457 221 23
Full Text Views 319 81 10
PDF Downloads 230 67 6
EPUB Downloads 0 0 0