Persistent Petroclival Meningioma. Combined Approach Resection: Anterior Petrosectomy and Infratemporal Approach

Abstract

Abstract. Combined skull base approaches are a challenging way to resect a persistent petroclival meningioma, which had several failed surgical attempts. The anterior petrosectomy and infratemporal approaches were combined to attempt the removal of this skull base lesion.

Objective. To present a less frequent but useful possibility to approach a complex pathology placed in the posterior skull base zone. 

Introduction. The anterior petrosectomy and the infratemporal approach have been described by Kawase, T. and Hakuba, A, respectively, to reach lesions that are localized in the medial and posterior skull base. In the particular case of our patient, the authors decided to carry out a combination of these two approaches as an unusual way to treat this kind of tumor which is reluctant to surgeries, and so treated with a full conventional dose of radiotherapy.

Discussion. The approaches described by Kawase and Hakuba have been widely spread all over the world since they were introduced as certain possibilities to handle pathologies occupying the medial and posterior skull base region.

Conclusion. The skull base approaches here described are indispensable tools that the neurosurgeons should incorporate in their knowledge in order to be used in some specific occasions. As it is well known, neither of these approaches are frequently indicated in our daily surgery work, but to know them well, to indicate them in the right way, and to perform them correctly will only redound in benefit to the patient by decreasing the complexity during the treatment of a difficult skull base pathology.