Combined Presigmoid-Subtemporal Approach in a Semi-Sitting Position for Petroclival Meningiomas: A Technical Report

Area of Science:

• Neurosurgery
• Skull Base Surgery

Background:

• Petroclival meningiomas (PMs) pose significant surgical challenges due to proximity to vital neurovascular structures.
• The combined presigmoid-subtemporal approach (CPSA) in a semi-sitting position for PM removal is not widely established.

Purpose of the Study:

• To evaluate the safety and efficacy of the CPSA in a semi-sitting position for resecting petroclival meningiomas.
• To determine the feasibility of this surgical approach through cadaveric dissection and clinical application.

Main Methods:

• The CPSA in a semi-sitting position was first standardized through neuroanatomic dissections in six adult cadaveric heads.
• Ten patients with petroclival meningiomas underwent surgical removal using the standardized CPSA in a semi-sitting position.

Main Results:

• Cadaveric dissections confirmed the feasibility and safety of the CPSA in the semi-sitting position for accessing petroclival tumors.
• All ten patients treated with this approach experienced successful tumor removal without any perioperative complications, comorbidities, or mortality.

Conclusions:

• The combined presigmoid-subtemporal approach in a semi-sitting position is a safe and effective technique for the surgical removal of petroclival meningiomas.
• This approach, supported by cadaveric validation, provides a reliable option for neurosurgeons managing challenging petroclival lesions.