• Vinicius Trindade Gomes da Silva, Marcos Queiroz Teles Gomes, Leila Maria da Roz, Vitor Nagai Yamaki, Prudente do Espirito SantoDepartment of Neurology, Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil., Manoel Jacobsen Teixeira, and Eberval Gadelha Figueiredo.
• Department of Neurology, Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: viniciustrindade@hotmail.com.
• World Neurosurg. 2021 Jul 1; 151: 110-116.

BackgroundTrigeminal neuralgia is defined by paroxysmal pain on the trigeminal nerve territory. The petroclival meningioma presents with trigeminal neuralgia in less than 5% of the cases. We report a case of a petroclival meningioma that encased the fifth nerve and was resected through a Kawase approach.Clinical PresentationA 67-year-old female patient presented paroxysmal shock pain in malar and ocular region with progressive worsening, evolving with daily crises despite the use of carbamazepine. On neurologic examination the patient was oriented, with no strength or coordination impairments. Cranial nerves exam showed left V1, V2, and V3 thermal and pain hypoesthesia, without allodynia. Normal strength in masticatory muscles was observed. Magnetic resonance imaging revealed a petroclival lesion with hypersign on T2 and contrast enhancement, suggestive of a meningioma. The tumor encased the trigeminal nerve at the entrance of the Meckel's cave. A temporal craniotomy with middle fossa peeling and anterior petrosectomy (Kawase approach) was performed and a Simpson II resection was achieved. The patient evolved with transient sixth nerve palsy, recovering completely after 3 months. During a follow-up of 5 years there was no evidence of tumor recurrence and the patient is free from pain without medication.ConclusionsThe Kawase approach is an interesting access for petroclival tumor resection.Copyright © 2021 Elsevier Inc. All rights reserved.

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