Combined Pre- and Retrosigmoid Approach for Petroclival Meningiomas with the Aid of a Rotatable Head Frame: Peri-Auricular Three-Quarter Twist-Rotation Approach: Technical Note

Abstract

We used the combined subtemporal presigmoid and suboccipital retrosigmoid multidirectional approach with the aid of a rotatable head frame (periauricular three-quarter twist-rotation approach) in 20 cases of petroclival meningiomas. Patients were placed in the lateral decubitus (park-bench) position. The head is twisted, rotated, and positioned 30 degrees face down in the Sugita rotatable head frame. By rotating this head frame, a 30- to 60-degree face-down position can be obtained when the suboccipital retrosigmoid route is used. Alternatively, the straight lateral or slightly brow-up position is obtained when the subtemporal presigmoid route is used. This twist-rotation approach provides multiple trajectories through the petroclival region with minimal drilling of the petrous bone, fatigue of the surgeon, and retraction of the brain.

Petroclival meningiomas: Surgical management and common complications

“…[8][9][10][11] Fujitsu et al describe a novel technique for varying the positioning of the patient's head during skull base surgery using the freedom of rotation offered by the Sugita head holder. 12,13 They applied this approach to a series of patients with petroclival meningiomas. The authors approached these tumors with combined transpetrosal approaches tailored to the anatomy of each individual patient.…”

Drainage Pathway of the Superior Petrosal Vein Evaluated by CT Venography in Petroclival Meningioma Surgery

“…In Case 1, because the tumor spread widely posteriorly and the collateral venous pathway (lateral mesencephalic vein) was clearly demonstrated preoperatively, a combined pre-and retrosigmoid approach, as a variation of the posterior TPA, was chosen, and a wide surgical field was obtained. 13 Although the SPV could not be visualized on postoperative CTV, no obvious venous complications occurred. In Case 2, despite the large size of the tumor, the Meckel's cave type SPV drainage was patent preoperatively.…”