Access Corridor for Intentionally Target Devascularization of Feeding Arteries of the Petroclival Meningioma

Background: Surgeries of petroclival meningioma is one of the most difficult and challenging operations in skull base cases. Devascularization of the tumor is basic step of the meningioma resection. Even complex petroclival meningioma surgery, surgical steps should be constructive and rational as same as the normal meningioma surgery. Devascularization, debulking, decompression, and dissection are basic steps but imperative technique. We consider again from the point of view of microdissection and use surgical procedures as rational steps and are used for surgery.

Objects: Considering the microanatomical location of the feeding arteries of the petroclival meningiomas, we performed target devascularization of feeding arteries through the surgical corridor to achieve early coagulation when the feeding arteries are able to embolizeby endovascular devascularization. Based on a microanatomical understanding of the location of feeding arteries, constructive operative strategy for devascularization and removal of the tumor compartment through individual access corridor and showing a concept of the compartment tumor removal of each artery.

Methods: The preoperative angiographical examination was performed and analyzed the vascularization in the petroclival meningioma (PCM) recent 10 cases. The feeding arteries were embolized by the endovascular team as much as possible. Surgery was performed following the target devascularization steps. Each artery was approached through the individual access corridors based on the anatomical location. The surgical results of patients operated per this strategy were compared with a historic series of patients who underwent conventional surgery.

Results: The surgical duration was reduced and the surgical result was improved. Endovascular embolization was effective for feeders from APA. MHT is difficult to embolize in most cases.