الفهرس 
Introduction
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Abstract
According to extension of petroclival meningiomas (PCM) to CPA and to the extent of our knowledge, no published study previously described a term of cerebellopontine angle petroclival meningioma (CPA PCM). We named CPA PCM to the meningiomas that originated from petrous apex and reached IAC or lateral to IAC. Different surgical approaches are commonly used for resection of these lesions such as transpetrosal approach (anterior and combined) and retrosigmoid approach. In this study we reviewed our records to evaluate the effectiveness of those different approaches in treatment of CPA-PCMs. The current study included 120 patients with CPA-petroclival meningiomas were admitted to the department of neurosurgery, keio university hospital between April 2005 and March 2017. from 2005 to 2017; 120 patients with CPA-petroclival meningioma were included in our study. These tumors were surgically removed by 3 different approaches. anterior transpetrosal approach (ATPA) was used in [68 cases], lateral sub-occipital approach (LSO) in [34 cases] and combined transpetrosal approach (CTPA) in [18 cases]. 32 (47.1%) patients with ATPA, 27 (79.4%) patients of LSO, and 7 patients (38.9%) of CTPA recovered well without any complications. All complications are transient and improved on follow up. We had no mortality in our study. CTPA has an operative time longer than ATPA and LSO, respectively. According to extent of tumor resection, presence of postoperative residual and recurrence on follow-up, we found that LSO was better than ATPA and CTPA in resection of tumors restricted to posterior cranial fossa only but ATPA and CTPA are preferred in tumors extended to posterior cranial fossa and middle cranial fossa. There is no statistically significant difference in tumor recurrence between different approaches The choice of surgical approach for CPA-petroclival meningiomas is based on the tumor size, location, extension, and their relationship with the surrounding neural and vascular structures. Also, the relation of tumor to IAC is considered an important factor in choosing the approach. ATPA was used in CPA-petroclival meningiomas mainly medial to IAC and extending lateral to IAC by 1 cm. CTPA is considered for cases medial and lateral to IAC more than 1cm. LSO is used in tumors mainly lateral to IAC.