Combined transtemporal access for large (>3 cm) meningiomas of the cerebellopontine angle

Large meningiomas of the cerebellopontine angle present a formidable surgical challenge due to tumor vascularity, neural attachment, and brain stem compression. The purpose of this paper is to present our use of the combined transtemporal approach in the surgical treatment of 29 large meningiomas. Twenty-nine patients with large meningiomas of the CPA were surgically treated through a combined retrosigmoid-transpetrosal-transcochlear approach at our tertiary care academic medical center from July 1995 through July 2004. Data was collected from a retrospective medical records review. Total tumor removal was achieved in 19 of 29 (67%) of the patients and the facial nerve was anatomically preserved in 26 of 29 (89%) of the cases. Cerebrospinal fluid leakage was seen in 3.5% of the patients and additional transient cranial nerve deficits were noted in 14% of the cases, but no significant neurologic sequelae occurred. Of the 10 patients with residual tumor, 6 have been stable without growth, 2 were treated with reoperation for regrowth of disease, and 2 were controlled with localized radiotherapy. This combined lateral transtemporal approach provided wide exposure to the cerebellopontine angle and optimized the surgical extirpation of 29 large meningiomas presented in this series. EBM rating: C-4