Excision of petroclival meningiomas remains a surgical challenge. Extradural anterior petrosectomy is widely used as a skull base approach for these tumors; however, this approach has significant procedure-related morbidity. The authors describe an alternative technique of tailored intradural petrosectomy for removal of petroclival meningiomas. This technique was used successfully in 5 patients. Gross-total or near-total resection was possible in 2 patients, whereas a subtotal removal was achieved in 3 patients, without significant morbidity. The petrous drilling was tailored depending on the extent of tumor. Transsylvian intradural anterior petrosectomy is a safe approach for petroclival meningiomas. This approach avoids problems related to subtemporal retraction and rationalizes the degree of bone drilling.
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