Fig. 4.

Patient with prior posterior fossa tumor resection and adjuvant whole-brain radiotherapy 20 years earlier. Neurological examination showed paralysis of all cranial nerves related to the cavernous sinus and right amaurosis, ataxia. The new MRI revealed an enlargement of the tumor extending into the upper clivus, orbit, infratemporal, and pterygopalatine fossae ( A and B ). A combined approach was used (fronto-orbito-zygomatic craniotomy with previous petrosectomy), with complete tumor resection and wide reconstruction using fat and a temporalis muscle flap ( C ). The siphon and petrous segment of the internal carotid artery were skeletonized after resection of the petrous apex in the Mullan's triangle and Kawase's triangle to resect tumor extensions into the pterygopalatine and infratemporal fossae, respectively ( D ). The patient died due to a postoperative hemispheric venous infarction and pulmonary sepsis 3 weeks after surgery. The pathological study demonstrated anaplastic meningioma. MRI, magnetic resonance imaging.