Anterior Petrosal [Kawase] Approach to Meckel's Cave Meningioma: 2-Dimensional Operative Video

Meningiomas arising from Dorello's canal(1-3) are a rare disease entity often resulting in an unclear diagnosis even at the time of surgery.(4,5) We present a case of a 63-yr-old man who presented with a sixth nerve palsy. He was found to have a lesion in the region of Meckel's cave on neuroimaging studies. Additionally, there were cutaneous and joint complaints that gave rise to a clinical possibility of sarcoidosis. The differential diagnosis also included meningioma or other inflammatory processes. The patient underwent a right-sided middle fossa approach and partial anterior petrosectomy (Kawase approach). Meckel's cave was opened, the tumor resected, and the petrosphenoid ligament (Gruber's) was identified. It was a meningioma. The case presentation, surgical anatomy, technique, and postoperative course and outcome are reviewed. The patient gave verbal consent for participating in the procedure and surgical video.