Encountering a Basal Vein of Rosenthal Variant during the Anterior Transpetrosal Approach

Background The basal vein of Rosenthal (BVR) is important in intracranial surgery, including skull base surgery. We report a case of petroclival meningioma in which a BVR variant drained into the tentorial sinus. Case Description An asymptomatic 62-year-old man was found to have a left petroclival meningioma during a routine examination. A "sliding-thin-slab" maximum intensity projection (MIP) was generated preoperatively using three-dimensional computed tomographic venography. It showed that the BVR variant drained into the free edge of the tentorium around the tumor. The tumor was removed via an anterior transpetrosal approach (ATPA); it was totally resected, and the vein was preserved with no detectable venous complications. Conclusions To our knowledge, this is the first study to describe surgery using the ATPA and involving a BVR variant, in which the vein was imaged successfully preoperatively using sliding-thin-slab MIP.