Combined retrosigmoid and middle fossa approach for a small, superiorly located petroclival meningioma: how I do it

Background Petroclival meningiomas pose significant surgical challenges because of their deep location and complex surrounding neurovasculature. The use of multiple surgical approaches can optimize safe tumor removal from multiple anatomic compartments. Method We describe a patient with a growing superior petroclival meningioma centered at the posterior clinoid with extension into Meckel’s cave that was successfully removed with a combined retrosigmoid and subtemporal middle fossa approach. This strategy avoided the need for anterior petrous bone drilling and tentorial splitting. Conclusion A combined retrosigmoid and subtemporal middle fossa approach can provide safe access to tumors spanning the supra- and infratentorial compartments.