Extended middle fossa approach for resection of a petroclival meningioma and vestibular schwannoma

A 69-year-old woman with refractory left facial pain and subtle left hearing decline had a 13.0 × 8.1–mm left petrous apex/Meckel’s cave meningioma and an 8.8 × 5.6–mm left intracanalicular vestibular schwannoma. She was otherwise neurologically intact. The anterior petrous and middle fossa approaches provide ideal access to these lesions individually, so an extended middle fossa approach was used to resect both in the same setting. She was neurologically stable postoperatively, except for a transient abducens palsy. Hearing was preserved on audiogram, and 4-month MRI displayed no tumors. The extended middle fossa approach provides excellent exposure of the petrous apex and internal auditory canal. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21258