The mini-pretemporal approach for skull base neoplasms: A technical note

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cranial Meningiomas

Background:

• Type 1 clinoidal meningiomas (ClinMens) arise from the inferior clinoid process, closely involving the internal carotid artery (ICA) and optic structures.
• Their proximity to vital neurovascular elements presents significant surgical resection challenges.
• This technical note explores a minimally invasive extradural approach for complex ClinMens.

Purpose of the Study:

• To illustrate the feasibility and microsurgical anatomy of the mini-pterional approach for type 1 clinoidal meningiomas.
• To demonstrate a minimally invasive extradural technique for complex skull base tumor resection.

Main Methods:

• A limited mini-pterional craniotomy was performed for extradural dissection of the middle fossa and anterior clinoidectomy.
• This approach minimized brain retraction while accessing the paraclinoid region.
• The surgical management of a 41-year-old female with visual decline due to a large type 1 ClinMen was described.

Main Results:

• Sequential extradural dissection, anterior clinoidectomy, and sharp dissection of neurovascular structures were feasible.
• Gross-total resection of the ClinMen was achieved.
• The patient experienced significant visual improvement post-operatively.

Conclusions:

• The mini-pterional approach, an adaptation of skull base techniques, facilitates safe and effective resection of selected ClinMens.
• Combining minimized craniotomy, extradural exposure, and early devascularization is key.
• Further studies are needed to confirm its reproducibility and advantages over traditional methods.