Our experience in petroclival lesions using a contralateral transmaxillary approach

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Endoscopic Surgery

Background:

• Petroclival lesions pose significant surgical challenges.
• Traditional endoscopic endonasal approaches may involve high morbidity maneuvers.
• A contralateral transmaxillary approach (CTA) is explored as a complementary technique.

Purpose of the Study:

• To evaluate the safety and efficacy of the contralateral transmaxillary approach.
• To assess its utility in managing petroclival lesions.
• To compare its benefits against the standard homolateral endoscopic endonasal approach.

Main Methods:

• Retrospective review of three patients with petroclival lesions.
• Surgical treatment using a combined ipsilateral transpterygoid and contralateral transmaxillary approach.
• Contralateral transmaxillary approach involved wide osteotomy of the maxillary sinus anterior wall via gingivolabial incision.

Main Results:

• Complete resection achieved for a cholesterol granuloma.
• Subtotal resection achieved for two macroadenomas.
• One patient experienced ecchymosis of the malar area as the sole complication.

Conclusions:

• The contralateral transmaxillary approach may enhance exposure and dissection in the petroclival area.
• It allows access to lateral and posterior regions without internal carotid artery manipulation.
• This approach offers a viable alternative for complex petroclival lesion management.