gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Management of petroclival meningiomas: a contribution to the surgical strategy related to the RISA approach

Meeting Abstract

  • Guilherme Lepski - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
  • Luis F.M. Silva Jr. - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
  • Kristopher Ramina - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
  • Florian Ebner - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
  • Florian Roser - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
  • Marcos Tatagiba - Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.15.07

doi: 10.3205/14dgnc212, urn:nbn:de:0183-14dgnc2129

Published: May 13, 2014

© 2014 Lepski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Since the retrosigmoid intradural suprameatal approach (RISA) was introduced into the neurosurgical context for resection of petroclival meningiomas, various reports published so far have focused on the anatomical advantages and disadvantages of this technique in comparison with others that are available. Nevertheless, considerably less attention has been paid to the clinical aspects, especially those concerning the functional outcome, duration of surgery and hospitalisation time. The aim of this study is to evaluate the effectiveness of the RISA for petroclival meningiomas, with special attention to surgery duration, stay on the intensive care unit and total hospital stay.

Method: To this end, we retrospectively enrolled 40 consecutive patients harbouring petroclival meningiomas who were submitted to surgical resection in our Institution. The retrosigmoid approach was performed in 39 cases; among these, in 11 cases the approach was extended into the middle fossa by drilling the suprameatal tubercle (RISA). Multivariate analysis was used to evaluate the influence of the approach used (RISA versus standard retrosigmoid), tumour extension, and surgical radicality on duration of surgery, stay on the Intensive Care Unit, and total hospitalisation time.

Results: Surgery lasted for significantly less time if the RISA extension was chosen (251 versus 314 minutes, p=0.03). Regarding permanence on the Intensive Care Unit, patients operated through the RISA route stayed for only 1.2 days, as compared with the 4 days necessary after a standard retrosigmoid approach (p=0.003). In total, the first group spent only 9.4 days in the Hospital, which was significantly less than the 14.8 day average in the second group (p=0.01). The multivariate analysis revealed that, across all variables analyzed (tumour extension, surgical approach and radicallity of surgical resection), only the surgical approach influenced the time spent in the ICU (p=0.03) and in the Hospital (p=0.04).

Conclusions: The RISA extension is a straightforward, safe and effective technique to resect petroclival meningiomas. This extension of the classic retrosigmoid approach facilitates surgical resection, implying a shorter surgical time and shorter ICU and hospital stays.