Petrous apex meningiomas: an alternative surgical approach

The literature describes a variety of surgical approaches to deal with meningiomas that involve the apex of the petrous bone and lie predominantly in the posterior fossa, e.g. the transpetrosal (translabyrinthine and transcochlear), the combined supra- and infratentorial, the subtemporal with or without pyramid resection, the suboccipital and the orbitozygomatic approaches. This study presents an alternative surgical approach, namely a modification of the occipital craniotomy with or without tentorial division. This approach was used for the removal of three petrous bone apex meningiomas which were medium to large in size and located predominantly in the posterior fossa with extension into the middle fossa. Complete tumour excision was achieved with no morbidity and no mortality.