The feasibility and clinical outcome of endoscopic transorbital transcavernous approaches with or without petrosectomy for petroclival lesions

OBJECTIVE Petroclival tumors such as petroclival meningiomas or trigeminal schwannomas extending to the posterior cranial fossa are challenging to treat due to their deep-seated location and proximity to critical neurovascular structures. This study aimed to evaluate the feasibility, safety, and clinical outcomes of endoscopic transorbital surgery for the resection of central skull base tumors involving the petroclival area. METHODS The authors conducted a retrospective analysis of 32 patients with petroclival tumors including meningiomas and trigeminal schwannomas who underwent endoscopic transorbital surgery between September 2017 and December 2022. Preoperative clinical and radiological data were collected, and patients were followed up postoperatively for a median period of 34.7 months. Surgical technique, complications, and clinical outcomes were assessed. RESULTS Endoscopic transorbital surgery provided a minimally invasive and direct corridor to the petroclival region. All 32 patients successfully underwent tumor resection, with gross-total or near-total tumor resection achieved in 28 patients. The mean tumor diameter was 3.5 cm. Based on tumor pathology, the endoscopic transorbital transcavernous trans-Meckel's cave approach (21 cases) or transorbital anterior transpetrosal approach (11 cases) was selected. The most common complication was facial paresthesia in 4 of 21 patients with trigeminal schwannomas and in 1 of 11 patients with petroclival meningiomas. Diplopia due to fourth cranial nerve injury occurred in 3 of 11 patients with petroclival meningiomas. Postoperative clinical improvement in neuralgic pain was observed in 3 of 4 patients. One patient developed a temporary facial palsy (House-Brackmann grade III) and another patient had transient paraparesis after removal of petroclival meningioma. CONCLUSIONS Endoscopic transorbital surgery appears to be a safe and effective technique for the resection of petroclival lesions, offering excellent visualization and access to the tumor while minimizing morbidity. However, further studies with larger patient cohorts and longer follow-up are warranted to validate the long-term efficacy and safety of this approach. This study contributes to the growing body of evidence supporting the utility of endoscopic transorbital techniques in skull base surgery.