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Posterior transpetrosal approach: less is more
Eric H Sincoff1, Sean O McMenomey, Johnny B Delashaw
1Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Neurosurgery
|February 14, 2007
Summary
The transcrusal variant of the posterior transpetrosal approach offers excellent surgical access to clival lesions. This technique enhances operative freedom while minimizing cranial nerve morbidity compared to other methods.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Surgical Anatomy
Background:
- The posterior transpetrosal approach is a complex surgical technique used for accessing lesions in the skull base.
- The transcrusal variant offers a specific corridor for lesions involving the clivus and posterior/middle fossae.
Observation:
- The study details the surgical steps of the posterior transpetrosal technique, emphasizing the transcrusal variant.
- Key steps include mastoidectomy, craniotomies, superior petrosal sinus ligation, and tentorium cutting.
Findings:
- Increased temporal bone resection in the transcrusal variant significantly enhances operative freedom and clival exposure.
- Further resection beyond the transcrusal variant yields minimal additional benefit but increases morbidity, particularly affecting cranial nerves VII and VIII.
Implications:
- The transcrusal variant provides a valuable lateral operative corridor for upper and middle clival lesions.
- This approach achieves exposure and operative freedom comparable to the transcochlear approach with reduced cranial nerve morbidity.
