Clinical Report: Utilizing a Three-Dimensional Exoscope for the Combined Petrosal Approach

Overview

This study evaluates the initial use of a 4K 3D exoscope in the combined petrosal approach for resection of petroclival meningiomas. Preliminary results indicate feasibility, although the small sample size limits definitive conclusions.

Background

Petroclival meningiomas (PCMs) are challenging to treat due to their deep location and proximity to critical neurovascular structures. The combined petrosal approach (CPA) enhances surgical exposure but can be ergonomically taxing with traditional techniques.

Data Highlights

Key Findings

• All patients presented with preoperative cranial nerve deficits.
• GTR was achieved in two out of three cases.
• One patient underwent planned STR followed by radiosurgery.
• Mean operative time was 9 hours and 40 minutes.
• Transient CN VI palsy resolved completely within three months.
• No intraoperative complications or mortality occurred.

Clinical Implications

Further studies with larger sample sizes are needed to validate these findings.

Conclusion

The initial experience with the 4K 3D exoscope in CPA for PCM resection suggests it is a viable adjunct, despite the limitations of a small sample size.

Related Resources & Content

1. Techniques for Resection of Tentorial Meningiomas Using a Subtemporal Approach with 3D Exoscope and Endoscope Integration, Journal of Neuro-Oncology, 2025 -- https://link.springer.com/article/10.1007/s00701-025-06456-0
2. A Modified Lateral Supraorbital Technique for Accessing Petroclival Junction Tumors Infiltrating the Anterior Cerebellopontine Region, Journal of Neuro-Oncology, 2016 -- https://link.springer.com/article/10.1007/s11060-016-2061-9
3. The Efficacy of Digital 3D Exoscope in Surgical Management of Falx and Parasagittal Meningiomas, Journal of Neuro-Oncology, 2024 -- https://link.springer.com/article/10.1007/s00701-024-06419-x
4. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), 2025 -- https://virtualtrials.org/pdf2025/cns.pdf?utm_source=openai
5. Approach-related complications of extradural anterior petrosal approach: systematic review and meta-analysis, PubMed, 2025 -- https://pubmed.ncbi.nlm.nih.gov/pubmed/40965718/?utm_source=openai
6. Techniques for Resection of Tentorial Meningiomas Using a Subtemporal Approach with 3D Exoscope and Endoscope Integration
7. Journal of Neuro-Oncology — A Modified Lateral Supraorbital Technique for Accessing Petroclival Junction Tumors Infiltrating the Anterior Cerebellopontine Region
8. The Efficacy of Digital 3D Exoscope in Surgical Management of Falx and Parasagittal Meningiomas
9. A Personal Approach to Retrosigmoid Intradural Inframeatal Petrosectomy
10. Three-Dimensional Exoscope-Assisted Combined Petrosal Approach for Petroclival Meningiomas: Technical Nuances from Early Experience
11. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
12. Approach-related complications of extradural anterior petrosal approach: systematic review and meta-analysis - PubMed