Resection of large petroclival meningiomas by the simple retrosigmoid route

The operative treatment of petroclival meningiomas has shown considerable i mprovement in recent years due at least in part to new developments in skul l base techniques, including the introduction of the modern transpetrosal a pproaches. Increased tumour resection and improved postoperative outcomes h ave been reported with the use of the transpetrosal approaches. Extensive e xperience in managing these tumours has shown, however, that in a subgroup of patients the transpetrosal approaches may not be indicated: either becau se of the increased surgical complications related to this approach, or bec ause of the unnecessarily large exposure in the individual cases. The autho rs report a recent experience dealing with 70 petroclival meningiomas, 24 o f which have been resected by the simple retrosigmoid approach. The indicat ion for the retrosigmoid route in the surgical management of the petrocliva l meningiomas, and its advantages and disadvantages compared to the transpe trosal method are discussed.