Surgical excision of clival tumors via the enlarged transcochlear approach. Indications and results.
BACKGROUND
The results of the surgical resection of 9 clival tumors using the enlarged transcochlear approach (ETCA) are evaluated. The literature is reviewed to compare the ETCA with other approaches to the clival and petroclival region; the surgical indications are discussed.


METHODS
Between June 1996 and June 1997, 9 patients were operated on through the ETCA either alone or combined with other approaches. Only meningiomas and chordomas with a significant involvement of the clivus and huge extension into the posterior fossa were included into this study.


RESULTS
Gross total tumor removal was achieved in 5 cases and in 4 cases a residual meningioma was left in place inside the cavernous sinus and treated by radiosurgery. No postoperative mortality or major neurological morbidity were recorded. The postoperative facial nerve function was good in 75% of cases. No tumor recurrence was recorded (mean follow-up = 45.9 months).


CONCLUSIONS
The indications to the ETCA should be as strict as possible. The ETCA is an effective procedure in the treatment of large clivopetrous tumors. Tumor characteristics like consistency, vascularity, encasements of vertebro-basilar vessels, bone erosion and previous surgery are also indicative. The transient postoperative facial nerve palsy and deafness should be considered as major disadvantages related to this approach.
Mortini
P
P
Skull Base and Endocrinoneurosurgery Center, Department of Neurosurgery, University Vita e Salute, S. Raffaele Hospital, Milan, Italy. mortini.pietro@hsr.it
Mandelli
C
C
Franzin
A
A
Giugni
E
E
Giovanelli
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002817:Chordoma / Q000175:diagnosis / Q000601:surgery*; D003051:Cochlea; D003388:Cranial Fossa, Posterior / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019635:Neurosurgical Procedures; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*