Petroclival meningiomas: Remaining controversies in light of minimally invasive approaches

•Petroclival meningiomas originate medial to cranial nerves V, VII, VIII, IX, X, XI.•Three main open surgical approaches can be used and may be combined.•The endoscopic expanded endonasal approach (EEA) can provide medial direct access.•A single retrosigmoid route can handle purely petroclival meningiomas.•Minimally invasive approaches, including neuroendoscopic ones, are emerging.

Surgical resection of petroclival meningiomas remains challenging due to their deep location and relationship to vital neurovascular structures. Although the natural history of these tumors involves a slow course, the incidence of cranial nerve deficits and the extent of tumor resection vary widely in the literature. Some reviews on this topic have been conducted, but data remain fragmentary and based on retrospective case series, which hinders attempts at meta-analysis. Within this context, research into the use of minimally invasive approaches, including in neuroendoscopy, continues to emerge. The objective of this narrative review is to analyze the available literature on the surgical treatment of petroclival meningiomas, with a focus on attempts at endoscopy-assisted resection.

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