posterior_intradural_petrous_apicectomy_approach

From 2005-2013, 29 patients with a petroclival meningioma underwent tumor removal through a PIPA approach. The approach consists of a retrosigmoid approach, intradural anterior resection of the petrous apex and microsurgical removal of the tumor, followed by endoscopic-assisted visualization and removal of tumor parts in the middle fossa or anterior to the brainstem.

Patients consisted of 7 men and 22 women; the mean age of patients was 52.7 years. In 24 patients, surgery was performed with the patient in a semisitting position; in 5 patients, surgery was performed with the patient in a supine position. A total resection was achieved in 19 patients (66%). A Karnofsky performance scale score >60% was recorded in 27 patients (93%), with surgical complications that involved a cerebrospinal fluid leak in 3 patients, bleeding in the surgical cavity in 2 patients, and pneumocephalus in 1 patient. The most frequent postoperative neurologic deficit was facial palsy (34%), which disappeared or improved consistently in all but 1 patient, who required a cranial nerve VII-cranial nerve XII anastomosis.

For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. The principal advantages of the PIPA approach are familiarity with the retrosigmoid route; the absence of temporal lobe retraction; and early control of the cranial nerves, vessels, and brainstem. However, careful patient selection regarding tumor extension is fundamental to obtaining optimal outcomes 1).


1)
Tatagiba M, Rigante L, Mesquita Filho P, Ebner FH, Roser F. Endoscopic-Assisted Posterior Intradural Petrous Apicectomy in Petroclival Meningiomas: A Clinical Series and Assessment of Perioperative Morbidity. World Neurosurg. 2015 Dec;84(6):1708-18. doi: 10.1016/j.wneu.2015.07.033. Epub 2015 Jul 23. PubMed PMID: 26210709.
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