{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:02:54Z","timestamp":1780131774258,"version":"3.54.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Despite the advances in skull base techniques, large petroclival meningiomas (PCMs) still pose a challenge to neurosurgeons. The authors\u2019 objective of this study was to describe a pretemporal trans\u2013Meckel\u2019s cave transtentorial approach for large PCMs and to report the surgical outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n From 2014 to 2017, patients harboring large PCMs (> 3 cm) and undergoing their first resection via this procedure at the authors\u2019 institute were included. In combination with pretemporal transcavernous and anterior transpetrosal approaches, the trans\u2013Meckel\u2019s cave transtentorial route was created. Surgical details are described and a video demonstrating the procedure is included. Retrospective review of the medical records and imaging studies was performed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 18 patients (6 men and 12 women) were included in this study, with mean age of 53 years. The mean sizes of the preoperative and postoperative PCMs were 4.36 cm \u00d7 4.09 cm \u00d7 4.13 cm (length \u00d7 width \u00d7 height) and 0.83 cm \u00d7 1.08 cm \u00d7 0.75 cm, respectively. Gross-total removal was performed in 7 patients, near-total removal (> 95%) in 7 patients, and subtotal removal in 4 patients (> 90% in 3 patients and > 85% in 1 patient). There were no surgical deaths or patients with postoperative hemiplegia. Surgical complications included transient cranial nerve (CN) III palsy (all patients, resolved in 3 months), transient CN VI palsy (2 patients), CN IV palsy (3 patients, partial recovery), hydrocephalus (3 patients), and CSF otorrhea (1 patient). Temporal lobe retraction\u2013related neurological deficits were not observed.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n A pretemporal trans\u2013Meckel\u2019s cave transtentorial approach offers large surgical exposure and multiple trajectories to the suprasellar, interpeduncular, prepontine, and upper-half clival regions without overt traction, which is mandatory to remove large PCMs. To unlock Meckel\u2019s cave where a large PCM lies abutting the cave, pretemporal transcavernous and anterior transpetrosal approaches are prerequisites to create adequate exposure for the final trans\u2013Meckel\u2019s cave step.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2018.1.focus17733","type":"journal-article","created":{"date-parts":[[2018,4,1]],"date-time":"2018-04-01T03:31:08Z","timestamp":1522553468000},"page":"E10","source":"Crossref","is-referenced-by-count":19,"title":["Pretemporal trans\u2013Meckel\u2019s cave transtentorial approach for large petroclival meningiomas"],"prefix":"10.3171","volume":"44","author":[{"given":"Chih-Hsiang","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui-To","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, and"},{"name":"National Yang Ming University, School of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Fu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, and"},{"name":"National Yang Ming University, School of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Ching","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Jung","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Taipei Veterans General Hospital; and"},{"name":"National Yang Ming University, School of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanford P. C.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, and"},{"name":"National Yang Ming University, School of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Hsiung","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, and"},{"name":"National Yang Ming University, School of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","first-page":"1225","article-title":"The Kawase approach to retrosellar and upper clival basilar aneurysms","volume":"44","author":"Aziz KM","year":"1999","unstructured":"Aziz KM, Tew JM Jr, Chicoine MR: The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery 44:1225\u20131236, 1999"},{"issue":"6 Suppl 3","key":"b2","series-title":"Neurosurgery","first-page":"1182","article-title":"Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review","volume":"62","author":"Bambakidis NC","year":"2008","unstructured":"Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, : Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 62 (6 Suppl 3):1182\u20131191, 2008"},{"key":"b3","series-title":"J Neurosurg","first-page":"667","article-title":"A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms","volume":"62","author":"Dolenc VV","year":"1985","unstructured":"Dolenc VV: A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667\u2013672, 1985"},{"issue":"1 Suppl","key":"b4","series-title":"Neurosurgery","first-page":"ONS13","article-title":"Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms","volume":"58","author":"Figueiredo EG","year":"2006","unstructured":"Figueiredo EG, Zabramski JM, Deshmukh P, Crawford NR, Spetzler RF, Preul MC: Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms. 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J Neurosurg 116:588\u2013597, 2012"},{"key":"b12","series-title":"J Neurosurg","first-page":"14","article-title":"Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension","volume":"123","author":"Tripathi M","year":"2015","unstructured":"Tripathi M, Deo RC, Suri A, Srivastav V, Baby B, Kumar S, : Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg 123:14\u201322, 2015"},{"key":"b13","series-title":"J Neurosurg","first-page":"463","article-title":"Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. 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J Neurosurg 62:667\u2013672, 1985"},{"issue":"1 Suppl","key":"b4","series-title":"Neurosurgery","first-page":"ONS13","article-title":"Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms","volume":"58","author":"Figueiredo EG","year":"2006","unstructured":"Figueiredo EG, Zabramski JM, Deshmukh P, Crawford NR, Spetzler RF, Preul MC: Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms. 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Neurosurgery 56 (2 Suppl):261\u2013273, 2005"},{"key":"b8","series-title":"Anat Anz","first-page":"7","article-title":"[The measurements of the clivus, the foramina on the external base of the skull and the superior vertebrae.]","volume":"169","author":"Lang J","year":"1989","unstructured":"Lang J, Issing P: [The measurements of the clivus, the foramina on the external base of the skull and the superior vertebrae.] Anat Anz 169:7\u201334, 1989 (Ger)"},{"key":"b9","series-title":"J Neurol Surg B Skull Base","first-page":"358","article-title":"Management of petroclival meningiomas: a review of the development of current therapy","volume":"75","author":"Maurer AJ","year":"2014","unstructured":"Maurer AJ, Safavi-Abbasi S, Cheema AA, Glenn CA, Sughrue ME: Management of petroclival meningiomas: a review of the development of current therapy. J Neurol Surg B Skull Base 75:358\u2013367, 2014"},{"key":"b10","series-title":"J Neurosurg","first-page":"363","article-title":"Gamma Knife radiosurgery of large skull base meningiomas","volume":"122","author":"Starke RM","year":"2015","unstructured":"Starke RM, Przybylowski CJ, Sugoto M, Fezeu F, Awad AJ, Ding D, : Gamma Knife radiosurgery of large skull base meningiomas. J Neurosurg 122:363\u2013372, 2015"},{"key":"b11","series-title":"J Neurosurg","first-page":"588","article-title":"Gamma Knife surgery for skull base meningiomas","volume":"116","author":"Starke RM","year":"2012","unstructured":"Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP: Gamma Knife surgery for skull base meningiomas. J Neurosurg 116:588\u2013597, 2012"},{"key":"b12","series-title":"J Neurosurg","first-page":"14","article-title":"Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension","volume":"123","author":"Tripathi M","year":"2015","unstructured":"Tripathi M, Deo RC, Suri A, Srivastav V, Baby B, Kumar S, : Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg 123:14\u201322, 2015"},{"key":"b13","series-title":"J Neurosurg","first-page":"463","article-title":"Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. 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J Neurosurg 67:463\u2013466, 1987"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/44\/4\/article-pE10.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/44\/4\/article-pE10.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/44\/4\/article-pE10.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:23:35Z","timestamp":1780129415000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/44\/4\/article-pE10.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":26,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2018.1.focus17733","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]}}}