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Anterior Petrosectomy With Intertentorial Approach.

Daniele Starnoni1,2, David Peters1,3, Lorenzo Giammattei1

  • 1Department of Neurosurgery, Lausanne University Hospital, Lausanne , Switzerland.

Operative Neurosurgery (Hagerstown, Md.)
|October 25, 2023
PubMed
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Tentorial peeling in the anterior petrosal approach (APIA) reduces risks to the temporal lobe and venous structures. This modification enhances surgical access to the petroclival region for complex skull base pathologies.

Area of Science:

  • Neurosurgery
  • Skull Base Surgery
  • Anatomical Dissection

Background:

  • The extradural anterior petrosal approach (EAPA) presents challenges due to critical structures in a narrow surgical corridor.
  • Potential risks of EAPA include temporal lobe and venous injuries.
  • Tentorial peeling offers a potential solution to mitigate these risks.

Purpose of the Study:

  • To evaluate the technique of tentorial peeling as a modification to the EAPA.
  • To assess the safety and efficacy of the anterior petrosectomy with intertentorial approach (APIA) via tentorial peeling.
  • To explore the benefits of APIA in managing petroclival region pathologies.

Main Methods:

  • Anatomical dissections were performed on five adult cadaveric heads.
  • The anterior petrosectomy with intertentorial approach (APIA) using tentorial peeling was completed.

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  • Step-by-step documentation and diagrammatic representations were created, including an illustrative case.

    • Main Results:

    • Tentorial peeling creates an additional dural layer, expanding the intertentorial space.
    • This technique allows for tailored dural incisions specific to the pathology.
    • It enables access to brainstem or skull base pathology while protecting the temporal lobe and basal veins.
    • APIA was successfully applied in a case of clival chordoma resection.

    Conclusions:

    • The anterior petrosectomy with intertentorial approach (APIA) is a valuable modification of the EAPA.
    • APIA reduces approach-related morbidity by minimizing temporal lobe exposure.
    • It maintains excellent access to the petroclival region and allows for customized durotomies.