Transpetrosal access to meningiomas juxtaposing the temporal bone

Meningiomas arising from the petroclival dura have presented a challenge to both otolaryngologists and neurosurgeons. Access by means of subtemporal, suboccipital, translabyrinthine, or transcochlear routes have inherent limitations both surgically as well as from resultant morbidity. Since 1988, the authors have used a transpetrosal transtentorial (combined subtemporal suboccipital presigmoid) approach to these lesions in selected cases. The goals of this technique have been to preserve function of the cranial nerves, to avoid excessive retraction of the temporal lobe and cerebellum, and to eliminate damage to the venous sinus and Labbés vein. Exposure of the base of the tumor for ablation of the blood supply and access for tumor removal is an important advantage of this approach.