The Pretemporal Transcavernous Approach to the Posterior Clinoid Process Chondrosarcoma with Intraoperative Neuromonitoring.

The pretemporal transcavernous approach (PTTCA) is used for complex aneurysms and skull base tumors. Four levels of PTTCA have been described depending on the extent of exposure of the cavernous sinus. The unfolding of dural layers between the lateral cavernous sinus membrane and temporal dura propria is a crucial step of the PTTCA. In this video article, we intend to demonstrate the surgical technique of the PTTCA with integration of multimodal intraoperative neuromonitoring to excise posterior clinoid chondrosarcoma. In this case, right frontotemporal craniotomy and PTTCA were employed to excise posterior clinoid chondrosarcoma. The surgical safety is improved by using an operative manoeuvre of tailored antegrade dural unfolding and judicious use of multimodal intraoperative neuromonitoring. The patient had an uneventful recovery and was functionally independent at the 3-month follow-up. Hence, we can conclude that the PTTCA is a valuable surgical technique for the lesions of the posterior clinoid process.