[Combined supra and infratentorial presigmoideo approach for lesions of the petrous and clival regions].
BACKGROUND
Petrous and petroclival lesions may be surgically treated with combinations of suprainfratentorial presigmoideo approach and microsurgical techniques.


OBJECTIVE
To demonstrate the utility and to present our surgical experiences with this approach.


METHODS
Thirteen patients with lesions of the clival, petrous region and of the cerebellopontine angle with extension toward the anterior portion of brainstem were taken to the operative room. There were nine women and four men. Eleven were adults and two children. The main clinical manifestations were headache (100%), dysfunction of cranial nerves (90%), ataxia (90%) hemiparesis (75%). There was papiledema in 45%. Petroclival meningiomas and schwannomas were the more frequent lesions. There were three patients with intraxial brainstem tumors and two arteriovenous malformations. There were not aneurysms. We performed nine retrolaberintic, three translaberintic and one transcochlear approach.


RESULTS
There was not severe incapacity, vegetative or dead patients. The surgical complications were facial nerve paresis (31%), cerebrospinal fluid leak (23%), decreased gag reflex (15%), abducens nerve paresis, hemiparesis and Claude Bernard Horner syndrome (8%). 50% of these complications disappeared three months later.


CONCLUSIONS
The suprainfratentorial presigmoidal approach and their surgical variations could be utilized to obtaining a low morbimortality, in the treatment of different neoplasm and vascular diseases of the petrous and petroclival region.
Servicio de Neurocirugía, Hospital Provincial, Camagüey, Cuba. svega@finlay.cmw.sld.cu
S
S
Vega-Basulto
J
J
Casares-Delgado
S
S
Silva-Adán
J
J
Montejo-Montejo
J
J
Santana-Alvarez
D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000473:pathology / Q000601:surgery; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002648:Child; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010579:Petrous Bone / Q000473:pathology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome