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Combined Microscopic-Endoscopic Transmastoid Resection of a Petrous Meningioma: 2-Dimensional Operative Video
Walid Ibn Essayed1, Emad Aboud2, Ossama Al-Mefty1
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
Abstract:
Petrous meningiomas are defined as tumors with a basal dural attachment on the posterior surface of the petrous bone.1 Their insertion can be anterior to the meatus (petrous apex meningiomas), or posterior to the meatus, with associated hyperostotic bony invasion either pre- or retro-meatal.2 These meningiomas are amenable to curative surgical removal and have better surgical outcomes than more medially located true petroclival meningiomas that originate medial to the fifth nerve.2-4 They, however, remain challenging because of their close relationship to critical neurovascular structures in the cerebellopontine angle.5 The posterior petrous meningiomas might reach a significant size with compression of the cerebellum, the brainstem, and involvement of the cranial nerves, and extend posteriorly to the transverse sigmoid sinus.2,6 Transmastoid approach with skeletonization and lateral reflection of the transverse sigmoid sinus provides a superb exposure without cerebellar retraction.6,7 The ease and complete resection of the tumor and invaded bone can be facilitated by combined microscopic-endoscopic techniques. We demonstrate these principles through the resection of a petrosal meningioma in a 56-yr-patient who presented with headaches, nystagmus, and mild cerebellar signs. The patient consented to the procedure. Image at 1:36 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998.
Insights
Petrous meningiomas, tumors on the petrous bone, can be surgically removed using a transmastoid approach. Combined microscopic-endoscopic techniques facilitate complete resection of these challenging cerebellopontine angle tumors.
Area of Science:
- Neurosurgery
- Oncology
- Skull Base Surgery
Background:
- Petrous meningiomas are tumors attached to the posterior petrous bone, posing surgical challenges due to proximity to vital neurovascular structures.
- These tumors can cause significant mass effect on the cerebellum, brainstem, and cranial nerves, potentially extending to the transverse sigmoid sinus.
Purpose of the Study:
- To demonstrate the efficacy of a transmastoid approach with combined microscopic-endoscopic techniques for petrous meningioma resection.
- To highlight the benefits of this surgical strategy in achieving complete tumor removal with minimal cerebellar retraction.
Main Methods:
- Surgical resection of a petrous meningioma using a transmastoid approach.
- Skeletonization and lateral reflection of the transverse sigmoid sinus for optimal exposure.
- Utilization of combined microscopic-endoscopic techniques to facilitate tumor and invaded bone resection.
Main Results:
- The transmastoid approach provided excellent exposure without the need for cerebellar retraction.
- Combined microscopic-endoscopic techniques enabled complete resection of the petrous meningioma and involved bone.
- The surgical principles were successfully demonstrated in a patient presenting with headaches, nystagmus, and cerebellar signs.
Conclusions:
- The transmastoid approach, augmented by combined microscopic-endoscopic techniques, is an effective method for resecting petrous meningiomas.
- This surgical strategy offers a safe and efficient means to achieve complete tumor removal while preserving critical neurovascular structures.
