By H. Krayenbühl, J. Brihaye, F. Loew, V. Logue, S. Mingrino, B. Pertuiset, L. Symon, H. Troupp, M. G. Yasargil

As an addition to the eu postgraduate education process for younger neurosurgeons we started to put up in 1974 this sequence dedicated to Advances and Technical criteria in Neurosurgery which was once later subsidized through the Euro­ pean organization of Neurosurgical Societies. the truth that the English language is easily so one can changing into the overseas medium at ecu medical meetings is a brilliant asset by way of mutual realizing. accordingly now we have determined to post all contributions in English, whatever the local language of the authors. All contributions are submitted to the total editorial board prior to e-book of any quantity. Our sequence isn't meant to compete with the guides of unique medical papers in different neurosurgical journals. Our goal is, relatively, to give fields of neurosurgery and similar parts within which very important contemporary advances were made. The contributions are written by means of experts within the given fields and represent the 1st a part of each one quantity. within the moment a part of every one quantity, we submit particular descriptions of normal operative systems, offered by way of skilled clinicians; in those articles the authors describe the options they hire and clarify the benefits, problems and hazards interested in some of the techniques. This half is meant essentially to aid younger neurosurgeons of their postgraduate education. even if, we're confident that it'll even be necessary to skilled, absolutely expert neurosurgeons.

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Very similar. Meningiomas of Basal Posterior Cranial Fossa 49 Fig. 23. ) CT scan demonstrating invasion of left petrosphenoclival trigonum with extension to the opposite side (arrows) Operative Approaches to the Clivus and to Clivus Meningiomas Although various subtemporal, suboccipital, and anterior routes have been developed to the clivus area (Decker and Malis 1970, Laine et al. 1977), none gives an ideal combination of direction and degree of exposure for the clivus meningioma. The site and direction of growth of the tumor may give the indication for the preferred approach.

Conclusion on Anterior Approaches Despite the great inventiveness and progress in developing anterior approaches to the clivus, at present no such approach is indicated in the surgery of clivus meningiomas (Derome 1977). As more progress is gained these routes may be of,benefit. They have been described here because of their great interest and poteritial, and because none of the presently used approaches to clivus meningiomas is entirely satisfactory. Surgery of Clivus Meningiomas 20 patients were operated upon in our clinic from 1967 -1979 via the following microsurgical approaches: Suboccipital......................................................................

If the tumor is midline the brainstem will be in the way, so that the exposure is poor unless the tumor has appreciable lateral extension. Posterolaterally displaced cranial nerves will be in the way of the access route to the tumor, though by this route they &re not approached blindly at the far side of the tumor. This approach is better for tumors at the pontine level than for those above or below. Anterior Approaches to the Clivus An excellent symposium review of these approaches is available (Laine et al.

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