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Lateral Petrous Meningioma

June 03, 2015


Resection of mengingiomas along the posterolateral petrous dura is quite straightforward. This is a 46 year-old male who presented with six month history of progressive gait difficulty and was diagnosed with mengingioma over the left aspect of the petrous dura. You can see the location of the tumor centered over the petrous bone. Some of the tumor extents toward the direction of the cerebellopontine angle, and most likely comes in contact with the cranial nerves. A left sided retromastoid craniotomy was completed, a lumbar puncture was performed at the beginning of the procedure, approximately 45 cc of CSF was removed. Here's the sigmoid sinus that was unroofed transverse sinus. Since early CSF drainage was accomplished, I was able to mobilize the tumor and the brain away from the dura and aggressively devascularize the tumor early safely without any risk of retraction injury to the brain. Now that most of the tumor is devascularized, I continue to debulk and dissect the tumor away from the cerebellum. Tumor is removed piecemeal with further decompression, I'm able to reach the cerebellopontine angles, tumor is mobilized away from the cerebellum. Here's the seventh and eighth cranial nerves. The vessels directly ending in the tumor are identified and coagulated and cut. Here's the dissection around the lower cranial nerves, again the tumor is rolled laterally and dissected away from the proximal segments of the seventh and eighth cranial nerves. Here's sharp dissection away from the seven and eighth cranial nerves. More tumor debulking is performed, tumor is rolled away from the brain stem. Here's dissection along the cerebellopontine angle, branches of the superior cerebellar artery. Here's a complete tumor disconnection, tentorium petrous dura, one of the branches of the SCA was found to be feeding the tumor. The very distal part of this vessel was disconnected at the level of the tumor capsule. Further inspection reveals no evidence of residual tumor. The petrous dura was further curated away and coagulated to minimize the risk of future tumor recurrence. Postoperative MRI demonstrates reasonable results and gross total removal of the mass. Thank you.

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