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The trans-sylvian trans-petrosal “half & half” approach—a how I do it

  • How I Do it
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Abstract

Background

Petroclival meningiomas are one of the most challenging tumors to be operated in the realm of neurosurgery. Many approaches have been developed over the years.

Method

The authors describe the Half & Half (H&H) approach whose main indication is petroclival meningiomas with suprasellar extension. The part of the tumor located above CN III and in the retrochiasmatic space is addressed through a trans-sylvian, while the petroclival portion is through an extradural anterior petrosectomy approach. The wide surgical corridor given by this approach allows extensive tumor resection while avoiding the risk associated with the manipulation of intracavernous neurovascular structures.

Conclusion

The H&H approach is an effective strategy to maximize the safe resection of petroclival meningiomas.

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Data availability

Not applicable.

Code availability

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Abbreviations

CN:

Cranial nerve

CSF:

Cerebro-spinal fluid

GSPN:

Greater superficial petrosal nerve

H&H:

Half & half

IAC:

Internal auditory canal

IPS:

Inferior petrosal sinus

MC:

Meckel’s cave

OTPF:

Orbito-temporal periosteal fold

SOF:

Superior orbital fissure

SPS:

Superior petrosal sinus

References

  1. Day JD, Fukushima T, Giannotta SL (1994) Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct. Neurosurgery 34:1009–1016

    CAS  PubMed  Google Scholar 

  2. Fournier HD, Mercier P, Roche PH (2007) Surgical anatomy of the petrous apex and petroclival region. Adv Tech Stand Neurosurg 32:91–146

    Article  CAS  PubMed  Google Scholar 

  3. Froelich SC, Aziz KM, Levine NB, Theodosopoulos PV, van Loveren HR, Keller JT (2007) Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery 61(5 suppl 2):179–185

    PubMed  Google Scholar 

  4. Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869–876

    Article  CAS  PubMed  Google Scholar 

  5. Muto J, Prevedello DM, Ditzel Filho LF et al (2016) Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region. J Neurosurg 125(5):1171–1186

    Article  PubMed  Google Scholar 

  6. Shibao S, Toda M, Orii M, Fujiwara H, Yoshida K (2016) Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach. J Neurosurg 124(2):432–439

    Article  PubMed  Google Scholar 

  7. Troude L, Carissimi M, Lavieille JP, Roche PH (2016) How I do it: the combined petrosectomy. Acta Neurochir (Wien) 158(4):711–715

    Article  PubMed  Google Scholar 

  8. Troude L, Bernard F, Baucher G, De La Rosa MS, Roche PH (2017) Extradural resection of the anterior clinoid process: how I do it. Neurochirurgie 63(4):336–340

    Article  CAS  PubMed  Google Scholar 

  9. Troude L, Baucher G, Roche PH (2022) Expanded middle fossa approach: the extradural anterior petrosectomy. In: Youssef AS (ed) Contemporary skull base surgery: a comprehensive guide to functional preservatiOn. Springer Nature, Switzerland AG, pp 453–464

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, North University Hospital, APHM, 13015, Marseille, France

    Lucas Troude, Talal Al-Shabibi, Guillaume Baucher & Pierre-Hugues Roche

Authors
  1. Lucas Troude
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  2. Talal Al-Shabibi
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  3. Guillaume Baucher
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  4. Pierre-Hugues Roche
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Contributions

All authors have made substantial contributions so as to qualify for authorship and have read and approved the final version of this manuscript. LT, TAS, and PHR: conception and design of the study. LT, TAS, and GB: acquisition of data and drafting the article. PHR: critically revised the article.

Corresponding author

Correspondence to Lucas Troude.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Informed consent was obtained from the illustrative case patient.

Consent for publication

The patient agreed for publication.

Conflict of interest

The authors declare no competing interests.

Additional information

This manuscript has not been previously published in whole or in part or submitted elsewhere for review.

Key points summary

- H&H approach provides a wide surgical corridor maximizing safe resection.

- Case selection: petroclival meningiomas with suprasellar extension.

- Preoperative workup including CT bone windows (petrous bone anatomy).

- Discuss the necessity to perform an extradural resection of the ACP.

- Avoid manipulation of the intracavernous portion of the tumor.

- Predict the course of CN IV and V before the dura opening.

- Optimize dura opening.

- Risk of postoperative temporal edema.

- Planned non-total tumor resection.

- Adjunctive radiosurgery on tumor residues.

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Troude, L., Al-Shabibi, T., Baucher, G. et al. The trans-sylvian trans-petrosal “half & half” approach—a how I do it. Acta Neurochir 166, 158 (2024). https://doi.org/10.1007/s00701-024-06056-4

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  • DOI: https://doi.org/10.1007/s00701-024-06056-4

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