Combined Petrosal Approach for Resection of Petroclival Meningioma with Endoscopic Assistance: Operative Video and Technical Nuances.

Petroclival meningiomas are formidable lesions due to their deep location in the skull base and proximity to critical neurovascular structures. The combined petrosal approach, comprised of an anterior petrosectomy and posterior retrolabyrinthine petrosectomy, allows for both supra- and infratentorial exposure of the tumor in the petroclival region while potentially preserving hearing function ( Fig. 1 ). In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petroclival meningioma via the combined petrosal approach. The nuances of microsurgical and skull base technique are illustrated including drilling of the petrous bone, transecting the tentorium, resection of the tumor, and multilayered reconstruction of the dural defect. The combined petrosal approach allows for multiple angles of attack including both subtemporal and presigmoid corridors. In summary, the combined petrosal approach with endoscopic assistance is an important strategy in the armamentarium for surgical resection of petroclival meningiomas ( Fig. 2 ). The link to the video can be found at: https://youtu.be/ipZb9kHcP2g .