Abstract
Background An anterior transpetrosal approach (ATPA) is suitable for treating upper petroclival lesions. However, the limit of the ATPA is reached when the tumor extends posterolaterally over the internal auditory canal (IAC) along the petrous edge. In such cases, ligation of the posterior part of the superior petrosal sinus (SPS) is necessary. To overcome this limitation, we combined the ATPA with a partial posterior petrosectomy in 8 patients who had petroclival meningiomas extending posterolaterally over the IAC. Methods We resected only the Trautmann triangle in addition to the Kawase triangle to secure the space to ligate the posterior portion of the SPS. Because the tympanic cavity and bony labyrinth of the ear were not exposed, we were able to preserve hearing function and lower the risk of cerebrospinal fluid leakage. Furthermore, this approach enables easy ligation of the SPS and the tentorium posterior to the tumor attachment. This combined technique also allows visualization of the petrosal vein, which is important for surgery of the posterior fossa. Results Total and near-total tumor removal was achieved in 6 patients (75%) with no permanent complications and no cerebrospinal fluid leakage. Postoperative hearing impairment was not found in any of the patients who underwent this surgery. Conclusions The ATPA combined with partial posterior petrosectomy is an effective method for removal of complicated petroclival meningiomas that extend posterolaterally over the IAC along the petrous edge.
| Original language | English |
|---|---|
| Pages (from-to) | 574-579 |
| Number of pages | 6 |
| Journal | World Neurosurgery |
| Volume | 84 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2015 Aug 1 |
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Keywords
- Anterior transpetrosal approach
- Petroclival meningioma
- Petrosal vein
- Superior petrosal sinus
- Trautmann triangle
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Anterior Transpetrosal Approach Combined with Partial Posterior Petrosectomy for Petroclival Meningiomas with Posterior Extension. / Shibao, Shunsuke; Borghei-Razavi, Hamid; Orii, Maaya; Yoshida, Kazunari.
In: World Neurosurgery, Vol. 84, No. 2, 01.08.2015, p. 574-579.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Anterior Transpetrosal Approach Combined with Partial Posterior Petrosectomy for Petroclival Meningiomas with Posterior Extension
AU - Shibao, Shunsuke
AU - Borghei-Razavi, Hamid
AU - Orii, Maaya
AU - Yoshida, Kazunari
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background An anterior transpetrosal approach (ATPA) is suitable for treating upper petroclival lesions. However, the limit of the ATPA is reached when the tumor extends posterolaterally over the internal auditory canal (IAC) along the petrous edge. In such cases, ligation of the posterior part of the superior petrosal sinus (SPS) is necessary. To overcome this limitation, we combined the ATPA with a partial posterior petrosectomy in 8 patients who had petroclival meningiomas extending posterolaterally over the IAC. Methods We resected only the Trautmann triangle in addition to the Kawase triangle to secure the space to ligate the posterior portion of the SPS. Because the tympanic cavity and bony labyrinth of the ear were not exposed, we were able to preserve hearing function and lower the risk of cerebrospinal fluid leakage. Furthermore, this approach enables easy ligation of the SPS and the tentorium posterior to the tumor attachment. This combined technique also allows visualization of the petrosal vein, which is important for surgery of the posterior fossa. Results Total and near-total tumor removal was achieved in 6 patients (75%) with no permanent complications and no cerebrospinal fluid leakage. Postoperative hearing impairment was not found in any of the patients who underwent this surgery. Conclusions The ATPA combined with partial posterior petrosectomy is an effective method for removal of complicated petroclival meningiomas that extend posterolaterally over the IAC along the petrous edge.
AB - Background An anterior transpetrosal approach (ATPA) is suitable for treating upper petroclival lesions. However, the limit of the ATPA is reached when the tumor extends posterolaterally over the internal auditory canal (IAC) along the petrous edge. In such cases, ligation of the posterior part of the superior petrosal sinus (SPS) is necessary. To overcome this limitation, we combined the ATPA with a partial posterior petrosectomy in 8 patients who had petroclival meningiomas extending posterolaterally over the IAC. Methods We resected only the Trautmann triangle in addition to the Kawase triangle to secure the space to ligate the posterior portion of the SPS. Because the tympanic cavity and bony labyrinth of the ear were not exposed, we were able to preserve hearing function and lower the risk of cerebrospinal fluid leakage. Furthermore, this approach enables easy ligation of the SPS and the tentorium posterior to the tumor attachment. This combined technique also allows visualization of the petrosal vein, which is important for surgery of the posterior fossa. Results Total and near-total tumor removal was achieved in 6 patients (75%) with no permanent complications and no cerebrospinal fluid leakage. Postoperative hearing impairment was not found in any of the patients who underwent this surgery. Conclusions The ATPA combined with partial posterior petrosectomy is an effective method for removal of complicated petroclival meningiomas that extend posterolaterally over the IAC along the petrous edge.
KW - Anterior transpetrosal approach
KW - Petroclival meningioma
KW - Petrosal vein
KW - Superior petrosal sinus
KW - Trautmann triangle
UR - http://www.scopus.com/inward/record.url?scp=84938749332&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938749332&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2015.03.055
DO - 10.1016/j.wneu.2015.03.055
M3 - Article
C2 - 25841755
AN - SCOPUS:84938749332
VL - 84
SP - 574
EP - 579
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
IS - 2
ER -