petroclival_meningioma_case_reports

Petroclival meningioma case reports

A 35-year-old male patient presented with dysphagia and impaired consciousness. Magnetic resonance imaging (MRI) showed a mass lesion with a wide base located at the clivus and anterior part of brain stem. Following surgical preparations, the mass was resected through the endoscopic endonasal transclival route. Presigmoid and lateral suboccipital approaches are the most popular methods for petroclival tumors. However, the disadvantages are restricted surgical corridor to reach the anterior lesions of the brain stem, and surgical manipulations that should be performed between the cranial nerves to gain access into the pathological structures. The alternative endoscopic endonasal transclival method, which is preferred to reach these lesions anteriorly, does not have these disadvantages. The endoscopic endonasal transclival route is suitable for meningiomas located in the retroclival area. With advances in endoscopic technology and surgical experience, full endoscopic endonasal transclival approach will be an alternative for the treatment of posterior circulation aneurysms, most of the extradural and intradural lesions of the ventral aspect of brain stem, and neuralgia secondary to vascular compression 1).

One of the most important and useful pieces of information in the preoperative evaluation of a large petroclival meningioma is the running course of the abducens nerve. The abducens nerve is small and has a long intracranial course, making it prone to compression by the tumor at various anatomical points. In relatively large tumors, it is difficult to confirm the entire course of the abducens nerve, even by heavy T2-thin slice imaging. Yang et al. report a case of successful preoperative estimation of the course of the abducens nerve that aided in its complete preservation during the resection of a large petroclival tumor 2).


1)
Gunaldi O, Kina H, Tanriverdi O, Erdogan U, Postalci LS. Endoscopic Endonasal Transclival Resection of the Upper Clival Meningioma. Turk Neurosurg. 2018;28(3):505-509. doi: 10.5137/1019-5149.JTN.17010-16.4. PubMed PMID: 27593835.
2)
Yang K, Ikawa F, Onishi S, Kolakshyapati M, Takeda M, Yamaguchi S, Ishifuro M, Akiyama Y, Morishige M, Kurisu K. Preoperative simulation of the running course of the abducens nerve in a large petroclival meningioma: a case report and literature review. Neurosurg Rev. 2017 Apr;40(2):339-343. doi: 10.1007/s10143-017-0816-1. Epub 2017 Jan 25. PubMed PMID: 28124175.
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