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Here is a resection of a petrosol meningioma. This is a 61 year-old female with a growing posterior fossa tumor, MRI evaluation revealed a classic petrosol meningioma also affecting the tentorium. Most of these tumors do not affect the contents of the CP angle and the removal therefore is relatively straightforward. Patient underwent a left sided retro mastoid or lateral suboccipital craniotomy. Here is this sigmoid sinus. Transfer sinus is located here. Here's the tumor. First maneuver involves devascularization of the tumor from the petrosal dura. Also the part of the tumor based or the petrotentorial junction is also devascularized. I use the lumbar drain to achieve early brain relaxation so that the tumor in the brain can be mobilized readily without much with retraction while the base of the tumor is being heavily devascularized. Here's a part of the petrous dura affected by the tumor. I continue to follow the contours of the petrous bone until I reach the posterior aspect of their CP angle cisterns. Here is the tentorium, petrotentorial junction Tumor base is coagulated and disconnected. Obviously I watch for the contents of the CP angle. Next, cottonoid patties are used to create a dissection planes between the tumor cerebellum interface. Here is another cottonoid patty creating the dissection planes. Continue to use these patties. Tumor is being reduced, and in this case, because of the availability of brain relaxation, I was able to remove the tumor essentially and block. Here is the connection between the tumor and petrotentorial junction. The contents of the CP angle cisterns are now apparent. Here are the final steps for disconnection of the tumor while maintaining the arachnoid planes or the CP angle structures. The final connection to the cerebellum is found and disconnected. The dura over the pitch response is heavily coagulated to minimize the future tumor recurrence. Here's the final view of the operative space. And in this case, post-operative MRI revealed adequate resection of the tumor without any complicating features. Thank you.
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