Excision of petroclival tumors by a total petrosectomy approach

The surgical removal of intradural petroclival tumors of any size is demanding because of the restricted surgical exposure and relation of the tumor with the brain stem, cranial nerves, and vertebrobasilar artery and branches. When petroclival tumors are large or giant sized and involve multiple areas of the clivus, adequate surgical exposure is difficult to achieve, yet is critical for safe tumor removal. In 17 patients with extensive petroclival tumors, total removal of the petrous bone was performed to gain a wide and shallow surgical exposure. This report details the intraoperative and postoperative complications, cranial nerve status, pre- and postoperative disability scores, and extent of tumor resection in these 17 patients. Deterioration of facial nerve function was the most common new cranial nerve injury following surgery. Three patients suffered major neurologic complications; six other patients suffered significant but temporary neurologic complications. Gross total tumor resection was accomplished in 9 of 17 patients, and most patients (15/17) maintained or improved their disability status. Tumor residual was related to cavernous sinus involvement, vascular encasement, or brainstem pial invasion. Total petrosectomy is an intensive and complex approach with inherent morbidity and thus should be reserved for extensive petroclival tumors that cannot be removed using less complicated approaches.