{"id":"5a0a8e56-ba9f-4d64-bd2f-da4dd282892b","slug":"semi-sitting-position-and-retrosigmoid-approach-for-a-large-petroclival-meningioma-resection-3-dimensional-operative-video","title":"Semi-sitting position and retrosigmoid approach for a large petroclival meningioma resection: 3-dimensional operative video","authors":["Rodrigo Uribe-Pacheco","Marcos Vinicius Sangrador-Deitos","Gerardo Yoshiaki Guinto-Nishimura","Juan Francisco Villalonga","Matias Baldoncini","Ramiro López Elizalde","Alvaro Campero"],"abstract":"Background: Petroclival meningiomas are still a neurosurgical challenge due to their proximity to cranial nerves and cerebral vasculature along the surgical corridor. The usual extension of large petroclival meningiomas is along the posterior fossa, frequently compromising and displacing adjunct cranial nerves such as the sixth and seventh-eight cranial nerve complex with brainstem compression, causing progressive neurological deficit and severe headache. The goal of sizeable petroclival meningioma surgery treatment is a maximal resection with preservation of neurological function. Several surgical approaches to the petroclival region have been described, and decisions depend on the valuable hearing, tumor origin, and lesion extension. Alongside, the semi-sitting position is a simple and feasible adaptation for several posterior fossa interventions, reducing venous hemorrhage and preventing venous air embolism. Case Description: Hereby, we present the case of a 39-year-old female patient with progressive intermittent headache and right-sided hemiparesis secondary to a large petroclival meningioma. After a careful case study, surgical treatment was performed employing a retrosigmoid approach, aiming for the safest and maximal resection possible. Conclusion: The retrosigmoid is an auditory sparing procedure that, with a semi-sitting position, provides direct visualization of the posterior fossa lateral triangles and the tumor and its dural implantation site with no blood and surgical view comprised of debris. This surgical video illustrates anatomical nuances and critical aspects of the retrosigmoid approach and semi-sitting position as safe and adequate access to complete resection and a favorable long-term clinical outcome. The patient consented to the procedure and the publication of his/her image. 00:40 - MRI findings compatible with petroclival meningioma[ 1 , 3 , 8 , 9 ] 00:50 - Tumor size, extension, and rationale for treatment and surgical approach decision.[ 4 , 6 ] 01:33 - Benefits of semi-sitting position[ 11 ] 01:43 - Surgical goal for petroclival meningioma with retrosigmoid approach[ 7 , 9 , 10 ] 08:45 - Disease background[ 2 , 5 ] Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. www.surgicalneurologyint.com The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/skull-base.png","publishDate":"2024-12-27T00:00:00.000Z","doi":"10.25259/SNI_911_2024","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/5a0a8e56-ba9f-4d64-bd2f-da4dd282892b/pdf"}