Meningiomas Petroclivais: Planejamento Cirúrgico. Petroclival meningiomas: surgical planning

Objective: The surgical management of tumors originating in the petroclival region or with extension into this area is a challenge to neurosurgeons. Here we describe two skull base approach to petroclival meningiomas, defining this, as tumors arising from the upper two thirds of the clivus, at the petroclival junction, and medial to the trigeminal nerve. Description: The cranio-orbito-zigomatic approach (COZ) is described for lesions located in the upper clivus with or without extension into the cavernous sinus, and the posterior petrosal approach used to reach lesions located in the middle clivus, with or without extension to the upper or lower clivus. The inferior extension of the COZ approach is the internal auditory canal.. Conclusions: Radical removal of meningiomas (grades 1 and 2 of Simpson rating scale) as the best treatment, is well established. Skull base approaches are more suitable for radical removal of petroclival meningiomas. Soft tumors such as trigeminal schwannomas , epidermoid cysts or meningiomas with extension into the petroclival region, but without attachment there, can be removed by retrosigmoid approach.