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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
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Intradural anterior transpetrosal approach
Shinya Ichimura1,2, Satoshi Hori1, Nils Hecht1
1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Neurosurgical Review
|April 5, 2016
Summary
A modified intradural anterior transpetrosal approach (ATPA) offers a safer alternative for petroclival lesions, reducing venous bleeding risks. This technique provides tailored exposure and straightforward surgery compared to the standard epidural ATPA.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Neurosurgical Techniques
Background:
- The standard anterior transpetrosal approach (ATPA) is a long-established epidural technique for petroclival lesions.
- This traditional method presents disadvantages, notably epidural venous bleeding near the foramen ovale.
Purpose of the Study:
- To introduce and evaluate a modified intradural ATPA technique for petroclival lesions.
- To overcome the limitations of the conventional epidural ATPA, specifically reducing venous bleeding.
Main Methods:
- A modified intradural anterior petrosectomy technique was employed in five patients with petroclival lesions.
- Surgical outcomes and intraoperative details of the intradural ATPA were meticulously recorded.
Main Results:
- Complete tumor removal was achieved in two meningiomas and two pontine cavernomas; subtotal removal in one meningioma without significant morbidity.
- No instances of cerebrospinal fluid leakage were reported.
- The intradural approach allowed for tailored petrosectomy and appeared more straightforward than the epidural route.
Conclusions:
- The modified intradural ATPA is a viable alternative, particularly for patients with extensive epidural venous routes.
- Potential challenges include managing temporal basal veins and identifying the petrous apex without epidural landmarks.
- Navigation using bone-window computed tomography is recommended for petrous apex identification.
