Temporal base intradural transpetrosal approach to the petoclival region: an appraisal of anatomy, operative technique and clinical experience

Abstract

Background. Tumours in the petroclival region have been a challenge to neurosurgeons. We present a cohort of 24 patients with petroclival meningioma (PCM) and trigeminal schwannoma (TS) in the petroclival region with extension to the middle fossa which were removed with the temporal base intradural transpetrosal (TBIT) approach.

Methods. To avoid damage to the important surrounding structures in the petrosal bone, a morphometric analysis in the TBIT approach was performed in 15 cadaveric heads, and the ‘safe area of intradural petrosectomy’ was identified in the TBIT approach. Subsequently, 14 patients with PCM and 10 patients with TS in the petroclival region were operated on with the TBIT approach.

Results. There were no operative deaths in this cohort related to the surgery. Common complications included light hemiparesis in two patients (8.0%), new cranial nerve paresis in nine (37.5%), post-operative pneumonia in one (4.0%) and transient cerebrospinal fluid leak in one (4.0%). Total tumour resection was achieved in 20 patients (83.3%) and subtotal resection in 4 (16.7%). There was no tumour recurrence in all patients at follow-up with a mean duration of 37 months.

Conclusions. Surgical strategy for PCM and TS in the petroclival region should be tailored to individual patients. The TBIT approach may improve the exposure of tumours in the petroclival region. A clear description of the ‘safe area of intradural petrosectomy’ appears to decrease the risk associated with petrosectomy procedure in the TBIT approach.

Key words:

• Anatomy
• meningioma
• petrosal bone
• skull base
• surgical approach
• trigeminal schwannoma

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.