Three-dimensional exoscope-assisted combined petrosal approach for petroclival meningiomas: technical nuances from...

Petroclival meningiomas (PCMs) are among the most challenging skull base tumors due to their deep location and proximity to critical neurovascular structures. The combined petrosal approach (CPA) provides wide exposure of the petroclival region, although conventional microscopic visualization may be ergonomically demanding in narrow operative corridors. The introduction of three-dimensional (3D) exoscopes offers enhanced magnification, improved ergonomics, and shared visualization. This study evaluates the feasibility and preliminary outcomes of CPA for PCM resection performed using a 4K 3D exoscope during its first year of clinical application.

Three consecutive patients underwent CPA for PCM resection using the ORBEYE™ 4K 3D exoscope between December 2024 and December 2025. Clinical data included demographics, pre- and postoperative neurological deficits, complications, operative time, extent of resection, and the 3-month outcomes. Gross total resection (GTR) was defined as the absence of residual enhancing tumor on postoperative MRI, whereas subtotal resection (STR) indicates intentional residual tumor left to minimize the risk of neurological injury.

The mean age at surgery was 50.7 years. All patients presented with preoperative cranial nerve (CN) deficits. GTR was achieved in two cases, while one patient underwent planned STR followed by radiosurgery. The mean operative time was 9 h and 40 min. One transient postoperative CN VI palsy completely resolved within 3 months, and one patient developed pneumonia that was successfully treated during hospitalization. No intraoperative complications or mortality occurred.

Although the limited sample precludes conclusions with regard to efficacy or superiority, our preliminary experience suggests that the 4K 3D exoscope is a feasible adjunct in CPA for PCM surgery, providing high-quality visualization and favorable early operative outcomes.