{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:40:31Z","timestamp":1782333631617,"version":"3.54.5"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The combined petrosal approach is a suitable technique for the resection of medium-to-large petroclival meningiomas (PCMs). Multiple technical modifications have been reported to increase the surgical corridor, including the method of dural and tentorial opening. The authors describe their method of dural opening and tentorial resection, and detail the microanatomy related to their technique to clarify pitfalls and effects.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The relationship of temporal bridging veins and cranial nerves (CNs) around the tentorial resection area was examined during the combined petrosal approach in 20 cadaveric specimens. The authors also reviewed their 23 consecutive clinical cases treated using this technique between 2002 and 2010, focusing on the effects and risks of the procedure.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In the authors' method, the tentorial resection extends from 5 to 10 mm anterior to the junction of the sigmoid sinus and the superior petrosal sinus (\u201csinodural point\u201d) to the trigeminal fibrous ring and the dural sleeve of CN IV. Temporal bridging veins enter the transverse sinus no more than 5 mm anterior to the sinodural point. The CN IV should be freed from its tentorial dural sleeve while avoiding disruption of the posterior cavernous sinus. The clinical data demonstrate a total resection rate of 78.3%, intraoperative estimated blood loss &lt; 400 ml at a rate of 80.9%, and a venous congestion rate of 0%.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Understanding the anatomical relationship between the tentorium and temporal bridging veins and CNs IV\u2013VI allows neurosurgeons the ability to develop a combined petrosal approach to PCMs that will effectively supply a wide operative corridor after resecting the tentorium, while significantly devascularizing tumors.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.11.jns11985","type":"journal-article","created":{"date-parts":[[2011,12,23]],"date-time":"2011-12-23T15:11:40Z","timestamp":1324653100000},"page":"566-573","source":"Crossref","is-referenced-by-count":31,"title":["Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas"],"prefix":"10.3171","volume":"116","author":[{"given":"Mari","family":"Kusumi","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"},{"name":"Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia; and"},{"name":"Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"},{"name":"Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankit I.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamidreza","family":"Aliabadi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan H.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyotaka","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-11-985","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","author":"Abdel Aziz","year":"2000"},{"key":"b2-11-985","series-title":"Acta Neurochir (Wien)","first-page":"1323","article-title":"The microsurgical anatomy of the cisternal segment of the trochlear nerve, as seen through different neurosurgical operative windows","volume":"144","author":"Ammirati","year":"2002"},{"issue":"5 Suppl 2","key":"b3-11-985","series-title":"Neurosurgery","first-page":"202","article-title":"Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review","volume":"61","author":"Bambakidis","year":"2007"},{"key":"b4-11-985","series-title":"Neurosurgery","first-page":"708","article-title":"Combined petrosal approach to petroclival meningiomas","volume":"51","author":"Cho","year":"2002"},{"key":"b5-11-985","series-title":"J Neurosurg","first-page":"20","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","author":"Couldwell","year":"1996"},{"key":"b6-11-985","series-title":"Neurosurgery","first-page":"1009","article-title":"Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct","volume":"34","author":"Day","year":"1994"},{"issue":"2","key":"b7-11-985","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical management of petroclival meningiomas: factors determining the choice of approach","volume":"19","author":"Erkmen","year":"2005"},{"key":"b8-11-985","series-title":"Skull Base Surg","first-page":"95","article-title":"Extradural total petrous apex resection with trigeminal translocation for improved exposure of the posterior cavernous sinus and petroclival region","volume":"6","author":"Fukushima","year":"1996"},{"key":"b9-11-985","series-title":"Fukushima Manual of Skull Base Dissection","first-page":"250","article-title":"Combined petrosal approach","author":"Fukushima","year":"2010"},{"key":"b10-11-985","series-title":"Minim Invasive Neurosurg","first-page":"340","article-title":"Tentorial incision in a lateral-medial direction with minimal retraction of the temporal lobe in the subtemporal transtentorial approach to the middle tentorial incisural space","volume":"51","author":"Hayashi","year":"2008"},{"key":"b11-11-985","series-title":"Neuroradiology","first-page":"656","article-title":"Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas","volume":"45","author":"Hirohata","year":"2003"},{"key":"b12-11-985","series-title":"Skull Base Surg","first-page":"130","article-title":"The middle fossa transpetrous approach for petroclival meningiomas","volume":"3","author":"Hitselberger","year":"1993"},{"key":"b13-11-985","series-title":"J Neurosurg Pediatr","first-page":"353","article-title":"The posterior petrosal approach: technique and applications in pediatric neurosurgery. 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