Posterior fossa meningiomas and its supra-tentorial extension, are mostly benign tumors.
They have the characteristic of involving vessels and cranial nerves with an invasive attitude, wrapping these neurovascular structures and making their dissection sometimes complex.
The surgery of these lesions involves a considerable variability in the approaches and therapeutic strategies. We basically manage posterior fossa meningiomas by the Transpetrous sistem approaches alone or combined.
The main advantages of the transpetrosal approach are:
1. Wide corridor to the lesion through a lateral route;
2. The transpetrosal approch allows the surgeon to work laterally to the cranial nerves and not between them;
3. Adequate room achieved drilling the petrous bone instead of heavy and prolonged retraction of the brain and cerebellum ;
4. Significant reduction of complications and therefore chance to achieve a radical or near-total removal, without any residual disease.
In case of extension of the lesion in the supratentorial compartement, the section of the tentorium by a lateral route, allows a good exposure of the interpenducolar cistern and midbrain without retraction of the temporal lobe and adequate control of the vessels of the posterior cerebral circulation.
The combination of these approaches provide a wide variety of solutions to control these lesions in an optimal way.
The therapeutic strategies in the treatment of meningiomas is shared with the patient in the process of counseling, describing all the possible alternatives that would preserve the main neurological functions.