• Rafael Martínez-Pérez, Asterios Tsimpas, Francisco Marin-Contreras, Rolando Maturana, Victor Hernandez-Alvarez, Mohamed A Labib, Tomas Poblete, Pablo Rubino, and Jorge Mura.
• Department of Neurosurgery, Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile. Electronic address: rafa11safin@hotmail.com.
• World Neurosurg. 2021 Nov 1; 155: e564-e575.

ObjectiveSphenopetroclival (SPC) meningiomas are considered among the most complex skull-base neoplasms to approach surgically. We aim to determine whether some SPC meningiomas can be safely and effectively treated using a modified minimally invasive pterional posterolateral transcavernous-transtentorial approach (MIPLATTA).MethodsFourteen patients harboring SPC meningiomas were surgically treated through a MIPLATTA. MIPLATTA includes a minipterional craniotomy, anterior extradural clinoidectomy, peeling of the temporal fossa, decompression of cranial nerves (CNs) in the cavernous sinus, and sectioning of the tentorium to reach the upper part of the posterior fossa.ResultsGross total resection was achieved in 11 of 14 patients (78%), whereas near-total resection was accomplished in the other 3 patients (22%), each of whom underwent a further complementary retrosigmoid approach for gross total tumor resection. There were no deaths, and 13 of 14 patients were independent at 6 months follow-up (modified Rankin Scale score ≤2). One patient had pontine infarction after the procedure and experienced moderate disability at follow-up (modified Rankin Scale score 3). All patients had some degree of CN impairment. Of 38 cranial neuropathies, 15 (39%) improved, 20 (53%) remained stable, and 3 (8%) worsened postoperatively. Four new CN deficits were observed postoperatively in 3 patients (fourth CN, 2 patients; third CN, 1; fifth CN, 1).ConclusionsMIPLATTA is a useful and safe treatment alternative that allows resection of large SPC tumors with dominant invasion of cavernous sinus and middle fossa, preserves hearing and facial motor function, and provides good chances of recovery of visual and oculomotor deficits.Copyright © 2021 Elsevier Inc. All rights reserved.

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