Semi-sitting position and retrosigmoid approach for a large petroclival meningioma resection: 3-dimensional operative...

Petroclival meningiomas are still a neurosurgical challenge due to their proximity to cranial nerves and cerebral vasculature along the surgical corridor. The usual extension of large petroclival meningiomas is along the posterior fossa, frequently compromising and displacing adjunct cranial nerves such as the sixth and seventh-eight cranial nerve complex with brainstem compression, causing progressive neurological deficit and severe headache. The goal of sizeable petroclival meningioma surgery treatment is a maximal resection with preservation of neurological function. Several surgical approaches to the petroclival region have been described, and decisions depend on the valuable hearing, tumor origin, and lesion extension. Alongside, the semi-sitting position is a simple and feasible adaptation for several posterior fossa interventions, reducing venous hemorrhage and preventing venous air embolism.

Hereby, we present the case of a 39-year-old female patient with progressive intermittent headache and right-sided hemiparesis secondary to a large petroclival meningioma. After a careful case study, surgical treatment was performed employing a retrosigmoid approach, aiming for the safest and maximal resection possible.

The retrosigmoid is an auditory sparing procedure that, with a semi-sitting position, provides direct visualization of the posterior fossa lateral triangles and the tumor and its dural implantation site with no blood and surgical view comprised of debris. This surgical video illustrates anatomical nuances and critical aspects of the retrosigmoid approach and semi-sitting position as safe and adequate access to complete resection and a favorable long-term clinical outcome. The patient consented to the procedure and the publication of his/her image.