Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University New Jersey Medical School, Newark, New Jersey.
Neurosurg Focus. 2017 Oct;43(VideoSuppl2):V8. doi: 10.3171/2017.10.FocusVid.17345.
The surgical management of petroclival meningiomas remains a formidable challenge. These tumors are deep in the base of the skull and arise medial to the fifth cranial nerve. In this operative video, the author demonstrates the extended middle fossa approach with anterior petrosectomy to resect an upper petroclival meningioma extending into Meckel's cave with brainstem compression. This approach is very useful for accessing deep tumors located above and below the tentorium, and between the fifth and seventh cranial nerves. Access to Meckel's cave is readily achieved by opening the fibrous ring of the porous trigeminus. This video demonstrates the operative technique and surgical nuances of the skull base approach, useful anatomic landmarks of the middle fossa rhomboid for safe petrosectomy drilling, pearls for cranial nerve and neuro-otologic preservation, and exposure of Meckel's cave. A gross-total resection was achieved, and the patient was neurologically intact. In summary, the extended middle fossa approach with anterior petrosectomy is an important strategy in the armamentarium for surgical management of petroclival meningiomas. The video can be found here: https://youtu.be/jttwJIYPHC8 .
岩斜脑膜瘤的手术治疗仍然是一个艰巨的挑战。这些肿瘤位于颅底深处，位于第五颅神经的内侧。在这个手术视频中，作者演示了扩展的中颅窝入路和前岩骨切除术，以切除一个延伸到桥小脑角并伴有脑干压迫的上岩斜脑膜瘤。这种方法对于接近位于小脑幕上方和下方、第五和第七颅神经之间的深部肿瘤非常有用。通过打开多孔三叉神经的纤维环，很容易进入桥小脑角。本视频演示了颅底入路的手术技术和细微之处，中颅窝菱形区对于安全的岩骨切除术钻孔的有用解剖标志，颅神经和神经耳科保护的要点，以及桥小脑角的显露。实现了大体全切除，患者神经功能完整。总之，扩展的中颅窝入路和前岩骨切除术是岩斜脑膜瘤手术治疗的重要策略。该视频可在此处查看：https://youtu.be/jttwJIYPHC8。
