Posterior Clinoid Meningioma-A Formidable Entity: 2-Dimensional Operative Video.

Abstract

Meningiomas originating from the posterior clinoid process are the rarest form of meningioma making up less than 1% of skull base meningiomas.1 These tumors have notoriously poor outcomes characterized by incomplete resections and a litany of complications.1 Owing to their scarcity and frequent confusion with meningiomas arising from adjacent skull base regions, the surgical anatomy, technical nuances, and potential pitfalls are not well addressed in modern literature. The most challenging aspect of the resection occurs while dissecting tumor in the retrosellar space.2 Meningiomas of neighboring regions such as those of the tuberculum, anterior clinoid process, or petrous apex, all arise from above the membrane of Liliequist which provides a plane of tumor dissection from the neurovascular structures of the posterior fossa. Posterior clinoid meningiomas arise from beneath this arachnoidal membrane and thus lack its protection while dissecting tumor from the basilar artery and its perforators.3,4 Surgical resection of these tumors requires meticulous intra-arachnoidal dissection of the encased basilar artery and its branches, and separation of tumor from the hypothalamus, cranial nerves, pituitary stalk, and brainstem while preserving their vascular supply. The combined petrosal facilitates a wide exposure reaching the entire central skull base for the safe visualization and dissection of tumor along the length of the basilar and the hypothalamus.5,6 The patient is a 68-year-old woman with hemiparesis and seizures from a posterior clinoid meningioma. The tumor was resected using the combined petrosal approach. The patient has consented to surgery and publication of images. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"VIDEO.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_279na25v"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}