Pterional Approach for Anterior Skull Base Midline Meningiomas against "The More The Merrier" Approach: An Institutional Experience

Pterional Craniotomy With Anterior Clinoidectomy for the Resection of a Sphenoid Ridge Meningioma: A Case Report and Two-Dimensional Operative Video

The pterional craniotomy with anterior clinoidectomy is a surgical technique used to resect sphenoid ridge meningiomas. It involves drilling the bone of the anterior clinoid process to gain access to the skull base, including the cavernous sinus and petrous apex particularly. This approach offers several advantages, including excellent exposure of the surgical site, minimal brain retraction, and the ability to visualize and protect critical neurovascular structures. We present a case of a 59-year-old woman presented with headache, dizziness, blurry vision, and unsteady gait for several months. The brain magnetic resonance imaging with gadolinium contrast showed a large space-occupying homogeneously-enhancing lesion at the left skull base, displacing the surrounding structures, including the frontal lobe, temporal lobe, and brainstem. Herein, we present the intraoperative video on a case in which the pterional craniotomy with anterior clinoidectomy that can allow the exposure and resection of the tumor extending into the posterior fossa was utilized for the resection of a large left sphenoid ridge meningioma with brain stem compression.