Middle Fossa Transcavernous Approach for Posterior Clinoid Meningioma

A 40-year-old woman presented with homonymous hemianopsia due to a left posterior clinoid meningioma compressing the left optic tract. The patient underwent a middle fossa transcavernous approach including extradural anterior clinoidectomy, intradural posterior clinoidectomy, and transection of petroclinoidal ligament to mobilize the oculomotor nerve. Gross total resection was obtained with improvement in visual fields. This case demonstrates methodical stepwise technique for a combined extradural intradural approach to resect tumors in the posterior clinoid region.