CP Angle and Meckels Cave Meningioma: Suprameatal Approach

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Let's discuss the use of the suprameatal osteotomy for removal of CP angle or petro tentorial tumors, reaching into the Meckel's Cave. This is a 53 year old female who presented with a right-sided trigeminal neuralgia. MRI evaluation reveals the location of the meningioma. Certainly centered over the petro tentorial region. Infiltrating into the Meckel's Cave. Patient underwent a right-sided extended retro mastoid craniotomy. Transfer sinus. Sigmoid sinus. You can see the petrous bone tentorium. The supra petros of sinus was coagulated and cut. And the tumor was exposed. You can see the base of the tumor over the junction of the tentorium and petrous bone. Seven and eighth cranial nerve, and a fifth cranial nerve, just anterior to the tumor. First I devascularized the tumor. Next I use various angled instruments, including brain curettes, to remove the part of the tumor infiltrating into the Meckel's Cave. I was able to remove part of the tumor using this method. The suprameatal tubercle was then drilled away, to expose the more lateral aspect of the nerve. This maneuver allowed removal of additional fragments of the tumor entering into the Meckel's Cave. Here's the final result. The nerve appears very relaxed. No residual tumor entering the Meckel's Cave. And post-operative MRI confirmed gross scarring over the mass, including the portion of the tumor infiltrating the Meckel's Cave. And the patients pain resolved after surgery. Thank you.

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