SURGICAL VIDEO

Resection of Large Petrotentorial

Tumor via a Retrosigmoid
Approach: 3-Dimensional
Operative Video
William T. Couldwell, MD, PhD

Downloaded from https://academic.oup.com/ons/article-abstract/16/2/272/5003029 by guest on 24 March 2019

Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt
Lake City, Utah

Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy144

Correspondence: William T. Couldwell, MD, PhD, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N Medical Drive East, Salt Lake City, UT 84132.
E-mail: neuropub@hsc.utah.edu

A 22-yr-old female college athlete had noted ataxia during
competitive gymnastic events. Magnetic resonance
imaging revealed a large tumor compatible with preop-
erative diagnosis of meningioma arising from the petro-
tentorial region with marked brainstem compression.
The technical challenges associated with this removal
include safe dissection of cranial nerves IV to VIII and
dissection from the brainstem and cerebellum, taking
care to not interfere with blood supply to these struc-
tures. The vascular tumor was removed via standard
suboccipital approach, with the trajectory above the
seventh/eighth nerve complex. The attachment was
at the petrotentorial junction, and the fourth nerve
KEY WORDS: Hemangiopericytoma, Petrotentorial, Ataxia, Retrosigmoid approach, Skull base
was intimately involved with the tumor as the tumor
was emanating from the tentorial edge where the
fourth nerve entered. In most instances, the nerves
are displaced by the tumor but in this case injury to
the fourth nerve ensued with dissection at the tumor
attachment. After tumor resection, the interrupted fourth
nerve was repaired microsurgically. A hemangioperi-
cytoma was identified on pathological analysis, and the
patient received postoperative radiation therapy, which
has been given postoperatively or at recurrence in the
literature. Technical nuances of removal are discussed.
Patient consent was granted for publication of this
video.

Operative Neurosurgery 16:272, 2019 DOI:10.1093/ons/opy144 Received, August 24, 2017. Accepted, May 8, 2018. Published Online, May 24, 2018.

Disclosure
The author has no personal, financial, or institutional interest in any of the
drugs, materials, or devices described in this article.

272 | VOLUME 16 | NUMBER 2 | FEBRUARY 2019 www.operativeneurosurgery-online.com