Minimal Anterior and Posterior Combined Transpetrosal Approach for Posterior Clinoid Process Meningiomas

Posterior clinoid process meningiomas (PCPMs) are extremely rare tumors arising from the central skull base and are surgically challenging because of their proximity to critical neurovascular structures. Although endoscopic endonasal approaches have been reported for small lesions, an optimal strategy for medium-to-large PCPMs remains controversial. To evaluate the surgical technique and clinical outcomes of the minimal anterior and posterior combined (MAPC) transpetrosal approach for medium-to-large PCPMs.

We retrospectively reviewed 5 consecutive patients with PCPMs who underwent microsurgical resection by the MAPC transpetrosal approach between 2018 and 2024. This approach involves limited petrous bone drilling combined with wide opening of Meckel's cave to mobilize the trigeminal nerve, providing a posterolateral corridor between the trigeminal and trochlear nerves. Surgical outcomes, extent of resection, complications, and follow-up results were analyzed.

The mean patient age was 54.6 years, and the mean tumor diameter was 33.7 mm. Gross-total resection was achieved in 2 patients (40%) and subtotal resection in 3 (60%). Transient cranial nerve deficits, mainly involving oculomotor nerves, occurred postoperatively but improved within 3 months. No surgery-related mortality, cerebrospinal fluid leakage, visual deterioration, or vascular complications occurred. Adjuvant stereotactic radiosurgery or radiotherapy was performed for residual tumors in 2 patients. During a mean follow-up of 55 months, no tumor recurrence was observed.

The MAPC transpetrosal approach provides a safe and effective surgical corridor for medium-to-large PCPMs and enables maximal safe resection with acceptable morbidity.