Suboccipital Suprameatal Approach for Petrosal Meningiomas Extended into Meckel's Cave

ABSTRACT

OBJECTIVE: The petrosal meningiomas involving the middle cranial fossa through the Meckel's cave represent a difficult surgical challenge. We report our experience of removing these lesions through the suboccipital approach combined with a technique that expose the Meckel's cave by removing the bony prominence located above the porus of the internal acoustic meatus, called the suprameatal tubercle, and the surrounding bone. METHODS: Between the period of January 1999 and October 2001, a total of seven patients with petrosal meningiomas involving the Meckel's cave were operated upon using suboccipital suprameatal approach. In the supine position, suboccipital craniotomy was performed. The main mass located predominantly within the cerebellopontine angle(CPA) was removed using intradural approach. The suprameatal tubercle was drilled-out to expose the Meckel's cave. And then, the tumor extended into the middle cranial fossa through the Meckel's cave was removed. RESULTS: In every case, the tumor extending into the Meckel's cave was exposed well. The tumors were completely removed in all patients without serious complications. CONCLUSION: We believe that suboccipital suprameatal approach offers a safe and effective method to remove some selected lesions of the CPA area extended into the middle cranial fossa through the Meckel's cave without the need for complex procedures, if the main mass is located predominantly in the CPA area.