Subtemporal Transtentorial Approach for Large Cerebello-Pontine Angle Meningioma

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The cerebello-pontine angle (C-P angle) is the most common location for meningiomas in the posterior fossa⁹⁾¹²⁾, and the posterior surface of the petrous bone is its most frequent site of dural attachment.²⁾ Two thirds of the meningiomas of the posterior fossa arise at the porus acousticus or just medial to it.¹⁰ The tumor as it enlarges has a predilection for extension into the region of the tentorial notch, causing an upward bulging of the tentorium with rostral protrusion of the upper surface of the cerebellum through the tentorial opening.¹¹⁾ The ease with which large subtentorial tumors with rostro-ventral overgrowth can be approached through a temporal route rather than a suboccipital route⁵⁾⁶⁾ led us to use this simple method of removing the large meningioma of the C-P angle through a large window of the tentorium, from above.