The Posterior Transpetrosal Approach for Petroclival Meningioma

Abstract

Surgical approaches to a petroclival lesion basically include the anterior transpetrosal, posterior transpetrosal and lateral suboccipital approaches. In this paper, the posterior transpetrosal approach is described. The posterior transpetrosal approach, in which the lesion is reached by drilling the posterior lateral part of the pyramid bone, posterior to the arcuate eminence, can obtain a wider operative field from the Meckel's cave to the jugular foramen without excessive brain retraction. As this approach requires a mastoidectomy, full understanding of the microsurgical anatomy of the mastoid bone is essential. The preoperative evaluation of the venous system including the vein of Labbe is also important. Surgical technical points are described by showing a representative case.