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J Neurol Surg B Skull Base 2016; 77(03): 231-237
DOI: 10.1055/s-0035-1566123
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study

Eric Mason
1   Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States
2   Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
,
Jason Van Rompaey
3   Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
,
C. Arturo Solares
1   Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States
2   Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
,
Ramon Figueroa
4   Department of Radiology, Georgia Regents University, Augusta, Georgia, United States
,
Daniel Prevedello
5   Department of Neurosurgery, Ohio State University, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

13 June 2015

03 September 2015

Publication Date:
29 October 2015 (online)

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Abstract

Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity.

Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region.

Methods The petroclival region was approached transclivally with EEA. Different aspects of dissection were compared with the posterior petrosal approach. The two approaches were also studied using CT analysis.

Results A successful corridor medial to the internal auditory canal (IAC) was achieved with EEA. Wide exposure was achieved with no external skin incisions, although significant sinonasal resection was required. The posterior petrosal was comparable in terms of exposure medially; however, the dissection involved more bone removal, greater skill, and a constricting effect upon deeper dissection. Importantly, access lateral to the IAC was obtained, whereas EEA could not reach this area.

Conclusion An EEA to the petroclival region is feasible. This approach can be considered in lesions medial to the IAC.

Keywords

cranial base - endonasal - endoscopic - petroclival region - posterior petrosal - skull base surgery - combined subtemporal retrolabyrinthine transpetrosal
 

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