Anterior Transpetrosal Approach Combined with Partial Posterior Petrosectomy for Petroclival Meningiomas with Posterior Extension

Shibao, Shunsuke; Borghei-Razavi, Hamid; Orii, Maaya; Yoshida, Kazunari

doi:10.1016/j.wneu.2015.03.055

Cited by 36 publications

(12 citation statements)

References 17 publications

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“…Intradural transpetrosectomy is ideal for petrous apex meningioma, especially for those with a predominant middle fossa extension, which can save much time to expose tumors and provide more surgical freedom when dealing with trigeminal nerve as compared with standard retrosigmoid approach [21]. But this approach is not ideal for tumors at the posterior fossa, because bone window is relatively small to provide space as a corridor to the posterior fossa [7,22].…”

Section: Discussionmentioning

confidence: 99%

Intradural Transpetrosectomy for Petrous Apex Meningiomas

Han

Zhang

Han

et al. 2019

J Korean Neurosurg Soc

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Objective This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve. Methods The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications. Results Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6–66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation. Conclusion PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Intradural Transpetrosectomy for Petrous Apex Meningiomas

Han

Zhang

Han

et al. 2019

J Korean Neurosurg Soc

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“…Once the PSC has been skeletonized, one can proceed to skeletonize the SSC guided by the location of the AE, solid cortical bone of the SSC, and location of the PSC. Likely with a similar concept in mind, Shibao et al 19 . described a limited mastoid resection termed “partial posterior petrosectomy,” where the Trautmann triangle is drilled out while avoiding the tympanic cavity and semicircular canals using neuronavigation and anatomical landmarks, i.e., AE and external auditory canal.…”

Section: Discussionmentioning

confidence: 99%

“…With the exception of Hafez et al.’s 27 modification of the dural opening in the combined transpetrosal approach reported by Cho and Al-Mefty, 14 the rest of the reported combined transpetrosal approaches9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22 require opening of the middle fossa dura and sectioning of the superior petrosal sinus and tentorium. Sectioning of the superior petrosal sinus and tentorium has a number of disadvantages.…”

Section: Discussionmentioning

confidence: 99%

“…It provides the surgeon with a wide corridor for visualization, dissection, and tumor resection. Over the years, this approach has been developed, used, and modified by numerous other surgeons 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22. The key elements of the approach are 1) temporo-suboccipital craniotomy, 2) mastoidectomy, 3) petrous apex resection, and 4) middle and posterior fossa dural opening with sectioning of the superior petrosal sinus and tentorium up to the tentorial incisura.…”

Section: Introductionmentioning

confidence: 99%

“…The key elements of the approach are 1) temporo-suboccipital craniotomy, 2) mastoidectomy, 3) petrous apex resection, and 4) middle and posterior fossa dural opening with sectioning of the superior petrosal sinus and tentorium up to the tentorial incisura. Either the craniotomy or the mastoidectomy can be performed first, with some surgeons favoring the former9, 10, 11, 14, 18, 19, 20 and others the latter 12, 13, 15, 16, 17, 21, 22. Resection of part9, 13 or all 12 of the semicircular canals further improves surgical exposure at the expense of hearing loss.…”

Section: Introductionmentioning

confidence: 99%

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The Transpetrosal-Ridge Approach: A Modification of the Combined Transpetrosal Approach

Tan

2019

World Neurosurgery: X

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Background Petroclival tumors are formidable challenges for skull base surgeons. Obtaining adequate surgical access is a paramount consideration. Although the combined transpetrosal approach provides a wide surgical corridor, it is technically challenging and, to a degree, morbid. This article describes the transpetrosal-ridge approach, which is a modification of the combined transpetrosal approach with improvements with regards to ease of execution and reduced surgical morbidity. Methods The key elements of the transpetrosal-ridge approach are outlined, followed by a detailed description of the steps. The head is placed in the lateral position. After skin incision and muscle elevation, a temporo-suboccipital craniotomy is performed. Middle fossa dura is elevated to the petrous ridge. A limited mastoidectomy is performed with preservation of the semicircular canals. The remaining petrous ridge is then resected and the posterior fossa dura is opened, with the opening extending through the trigeminal dural ring. Results Steps of the combined transpetrosal approach that do not contribute to the final surgical corridor are omitted. Extensive mastoid and petrous apex resection is avoided. Posterior fossa dural opening extending through the trigeminal dural ring is a critical step, as it detaches the superior petrosal sinus and sigmoid sinus from the petrous bone. With the retraction of the temporal lobe and the cerebellum and sigmoid sinus, a wide surgical corridor is obtained. Conclusions The transpetrosal-ridge approach is a modification of the combined transpetrosal approach with optimization of the operative steps while continuing to provide a wide surgical corridor to the petroclival region.

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