Diverse accessory techniques and working corridors to enhance the retrosigmoid approach: a versatile option for the treatment of meningiomas of the petroclival region.

BACKGROUND

Meningiomas of the petroclival region (MPR) are among the most challenging skull base tumors to manage surgically. Historically, their treatment carried high risks and significant mortality due to the complex anatomy and proximity to critical neurovascular structures. Advances in microsurgical techniques and neuroimaging have significantly improved surgical outcomes. The retrosigmoid approach is a well-established technique for accessing the posterior cranial fossa, further enhanced by specific working corridors and accessory techniques.

OBJECTIVE

To illustrate the versatility of the retrosigmoid approach in managing MPR, emphasizing accessory techniques and tailored working corridors to optimize outcomes.

METHODS

Between January 2015 and August 2024, 32 patients with MPR underwent surgical resection using the retrosigmoid approach in the semi-sitting position. Surgical videos were analyzed to identify working corridors and accessory techniques. Preoperative clinical status, extent of resection, and postoperative outcomes were evaluated.

RESULTS

The study included 32 patients (mean age: 56.2 years; 46.9% female). Accessory techniques were used in 28.1% of cases, including suprameatal tubercle drilling (12.5%), tentorial sectioning (9.4%), and petrous apex drilling (6.2%). Working corridors were adapted based on tumor location: the lateral cerebellar corridor alone was used in 37.5%, supracerebellar alone in 12.5%, and both combined in 50%. New or progressive cranial nerve deficits occurred in 18.75% of patients. No major complications, such as cerebrospinal fluid leakage or infections, were reported.

CONCLUSIONS

This study demonstrates how accessory techniques and tailored working corridors enhance the retrosigmoid approach's versatility, establishing it as a safe and effective option for MPR resection.

CLINICAL TRIAL NUMBER

Not applicable.