Meningiomas of the Skull Base: Chapter 12, Middle Fossa Floor Meningiomas

Little is known regarding meningiomas that primarily arise from the floor of the middle fossa as opposed to the other middle fossa meningiomas. In this chapter, we treat this relatively new entity, including primary Meckel’s cave (MC) meningiomas because they respect similar anatomical landmarks. Meningiomas of the middle cranial fossa can be approached by two distinct routes: an anterolateral approach or a lateral approach; in other words, via a pterional or a subtemporal approach. Both approaches can be further extended by means of additional osteotomies, such as the cranio-orbital zygomatic approach and the temporo-zygomatic approach. “Extended” approaches and adequate cerebrospinal fluid drainage, are helpful to achieve a “retractorless” surgical technique. It is also mandatory to achieve good surgical outcomes to preserve venous structures, as the vein of Labbè. The aim of this chapter is to treat “middle fossa floor” meningiomas as a clinical entity that is distinct from meningiomas arising from the sphenoid wing and cavernous sinus, which have been already described in other chapters of this book, and to include in authors’ classification primary MC meningiomas as well