Combined Pre- and Retrosigmoid Approach for Petroclival Meningiomas with the Aid of a Rotatable Head Frame: Peri-Auricular Three-Quarter Twist-Rotation Approach: Technical Note

We used the combined subtemporal presigmoid and suboccipital retrosigmoid multidirectional approach with the aid of a rotatable head frame (periauricular three-quarter twist-rotation approach) in 20 cases of petroclival meningiomas. Patients were placed in the lateral decubitus (park-bench) position. The head is twisted, rotated, and positioned 30 degrees face down in the Sugita rotatable head frame. By rotating this head frame, a 30- to 60-degree face-down position can be obtained when the suboccipital retrosigmoid route is used. Alternatively, the straight lateral or slightly brow-up position is obtained when the subtemporal presigmoid route is used. This twist-rotation approach provides multiple trajectories through the petroclival region with minimal drilling of the petrous bone, fatigue of the surgeon, and retraction of the brain