The mini-pretemporal approach for skull base neoplasms: A technical note

Background: Type 1 clinoidal meningiomas (ClinMens) grow from the inferior part of the clinoid process and are closely associated with the internal carotid artery (ICA) and optic apparatus. Surgical challenges stem from the intimal relation with the vascular adventitia and perineurium. Their intimate relationship with vascular and neural structures poses significant challenges for safe resection. This technical note illustrates the feasibility and microsurgical anatomy of a minimally invasive extradural route – the mini-pretemporal approach – applied to a representative case of complex ClinMen. Methods: We describe the surgical management of a 41-year-old female presenting with subacute visual decline due to a large type 1 ClinMen with extensive vascular encasement. Through a limited mini-pterional craniotomy with extradural dissection of the middle fossa and anterior clinoidectomy, access to the paraclinoid region was achieved while minimizing brain retraction. Results: Sequential extradural middle cranial fossa peeling, anterior clinoidectomy, and circumferential sharp dissection of key neurovascular structures were technically feasible and facilitated gross-total resection with visual improvement. Conclusion: The mini-pretemporal approach represents an adaptation of established skull base techniques rather than a new procedure. By combining minimized craniotomy, extradural exposure, and early devascularization, it may facilitate safe and effective resection in selected ClinMens. Further experience in larger cohorts will be necessary to confirm its reproducibility, safety, and comparative advantages over traditional approaches.