Endoscopic Endonasal Transclival Approach to the Petroclival Meningioma

Abstract

Objective: The current management paradigm for petroclival meningioma includes surgical approaches utilized extensive bone drilling, brain retraction, and cranial nerve manipulation. We have experienced a new approach such as the endoscopic endonasal transclival approach to the petroclival meningioma. Patients/material and Methods: We used the endoscopic endonasal approach in a patient who was a 53-year-old lady suffered from the petroclival meningioma incidentally found. The patient underwent the embolization of the tumor feeding vessels from biexternal carotid arteries to reduce the bleeding using ethanol substance and the next day, we tried to remove the tumor directly to the basement of the tumor along the transnasal corridor without brain retraction. During operation we used bilateral nasal pedicle flaps to prevent the CSF leakage and the navigation system for the detection to the correct position of the manipulation to the tumor. Results: The tumor was subtotally removed without massive bleeding and no CSF leakage occurred. The patient has had no neurological deficits at the postoperative state. Conclusions: The endoscopic endonasal transclival approach to the petroclival meningioma could be found sort of innovative because of a less invasive and more direct approach than a traditional transcranial approach from this case. This approach to the petroclival meningioma would represent more sophisticated and widespread approach in the future.