Trans-sylvian transtentorial approach for skull base lesions extending from the middle fossa to the upper petro-clival region

Abstract

Various transpetrosal approaches have been described for excision of lesions extending into both the midlle fossa and the upper petroclival region. These approaches may be associated with significant morbidity. Six patients with lesions along the medial part of the middle fossa and the upper petroclival region were operated by the trans-sylvian transtentorial approach. The surgical corridor was along the tentorial edge with excision of the tentorium providing adequate access to the tumour without the need for petrosectomy. Three patients had a trigeminal schwanomma, one each had a petroclival meningioma, clival chordoma and an epidermoid tumour. In 5 patients a total/neartotal excision was achieved while in one patient with petroclival meningioma, a subtotal excision was possible. All patients improved clinically after the surgery. There was no procedure related morbidity. The transsylvian transtentorial approach provides adequate acces to upper petroclival lesions allowing the tumours in this region to be removed without the need for a petrosal resection.

Key words:

• Petroclival tumours
• petrosal approaches
• trans-sylvian trans-tentorial approach
• tentorial excision