Resection of large petroclival meningiomas by the simple retrosigmoid route

The operative treatment of petroclival meningiomas has shown considerable improvement in recent years due at least in part to new developments in skull base techniques, including the introduction of the modern transpetrosal approaches. Increased tumour resection and improved postoperative outcomes have been reported with the use of the transpetrosal approaches. Extensive experience in managing these tumours has shown, however, that in a subgroup of patients the transpetrosal approaches may not be indicated: either because of the increased surgical complications related to this approach, or because of the unnecessarily large exposure in the individual cases. The authors report a recent experience dealing with 70 petroclival meningiomas, 24 of which have been resected by the simple retrosigmoid approach. The indication for the retrosigmoid route in the surgical management of the petroclival meningiomas, and its advantages and disadvantages compared to the transpetrosal method are discussed.