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      Microsurgical Resection of Giant Petroclival Meningioma via the Posterior Petrosal Approach: 2-Dimensional Operative Video.

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          Abstract

          Petroclival meningiomas are challenging deep-seated lesions related to many critical neurovascular structures of the skull base.1-5 We present the case of a 45-year-old male presenting with a 3-year history of progressive headache associated gradually with multiple cranial nerves deficits and progressive tetraparesis leading to use of a wheelchair (Video 1) Preoperative magnetic resonance imaging demonstrated a mass highly suggestive of a giant left petroclival meningioma. Considering worsening of symptoms and impressive mass effect, microsurgical resection employing the posterior petrosal approach was performed. Mastoidectomy with skeletonization of semicircular canals and a craniotomy approaching both posterior and middle cranial fossae were done. Dural incision at the base of the temporal lobe was communicated to other incision in the presigmoid dura by ligation and sectioning of superior petrosal sinus. Tentorium was cut all the way toward the incisura, with attention to preserve the fifth nerve along its division and fourth nerve in the last cut. After a complete tentorium incision, the presigmoid space enlarged, exposing both supratentorial and infratentorial spaces. The lesion was totally resected employing microsurgical techniques. Postoperative magnetic resonance imaging demonstrated complete tumor resection. The patient experienced improvement of complaints and no new neurologic deficit on follow-up. The posterior petrosal approach gives great exposure and a more lateral angle of attack to the ventral surface of brainstem, allowing in this case to approach the whole tumor attachment. Informed consent was obtained from the patient for the procedure and publication of this operative video. Anatomic images were courtesy of the Rhoton Collection, American Association of Neurological Surgeons/Neurosurgical Research and Education Foundation.

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          Author and article information

          Journal
          World Neurosurg
          World neurosurgery
          Elsevier BV
          1878-8769
          1878-8750
          Oct 2022
          : 166
          Affiliations
          [1 ] Department of Neurosurgery, Mackenzie Evangelical University Hospital, PR, Brazil.
          [2 ] Department of Neurosurgery, Federal University of Paraná, Curitiba, PR, Brazil.
          [3 ] Department of Neurosurgery, Mackenzie Evangelical University Hospital, PR, Brazil; Department of Neurosurgery, Federal University of Paraná, Curitiba, PR, Brazil.
          [4 ] Department of Neurosurgery, Mackenzie Evangelical University Hospital, PR, Brazil; Department of Neurosurgery, Federal University of Paraná, Curitiba, PR, Brazil. Electronic address: luisborba@me.com.
          Article
          S1878-8750(22)01108-1
          10.1016/j.wneu.2022.08.008
          35963609
          bf28abd5-f9e9-4aa8-b065-eb1b7bfcfb79
          History

          Meningioma,Petroclival,Posterior petrosal,Skull base,Tumor
          Meningioma, Petroclival, Posterior petrosal, Skull base, Tumor

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