Surgical approaches to petroclival meningiomas part I: upper and midclival approaches

Strictly considered, petroclival meningiomas represent only a percentage of the 10% of all intracranial meningiomas that reside in the posterior fossa. Although not statistically frequent, with their location in proximity to cranial nerves, the basilar artery and its perforating branches, and the brainstem, these tumors have been considered to represent some of the most formidable challenges in skull base surgery. It is n o surprise that the removal of petroclival meningiomas historically has been associated with high morbidity and mortality; in testimony to this fact, before 1970 the reported risk of mortality from resection of petroclival meningiomas was > 50%. Indeed, a successful total removal was reported in only one case prior to 1970, and as recently as 1967 these tumors were deemed by some authorities to be inoperable. However, left unchecked, continued growth of these tumors in this location will result in a natural history of brainstem compression with ultimate progression to fatality.