title: Middle skull base approach with posterolateral mobilization of the geniculate ganglion to access the clival regions.
abstract: BACKGROUND
  Clival lesions remain one of the most challenging intracranial tumors to treat surgically. Many skull base approaches have been described to improve resection and to decrease patient morbidity.
  
  
  OBJECTIVE
  To describe a middle skull base approach with posterolateral mobilization of the geniculate ganglion of the facial nerve to access the clival regions.
  
  
  METHODS
  Three patients with petroclival chordoma and 1 patient with petroclival meningioma underwent surgical resection of lesions with our new procedure. Surgical techniques consisted of temporal craniotomy and exposure of the facial nerve from the tympanic segment to the labyrinthine segment, keeping the fundus of the internal auditory canal intact. The geniculate ganglion was mobilized posterolaterally, followed by drilling of the cochlea and exposure of the Dorello canal.
  
  
  RESULTS
  Four lesions were successfully removed with complete preservation of facial nerve function.
  
  
  CONCLUSIONS
  This approach is a modification of the Goel procedure in which the facial nerve from the tympanic segment to the cisternal segment was totally mobilized. Our procedure carries less risk to the facial nerve function than the Goel procedure and provides sufficiently wide exposure of clival lesions.
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan. hmorisako@med.osaka-cu.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Morisako
authors.forename: Takeo
authors.initials: T
authors.lastname: Goto
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagata
authors.forename: Isao
authors.initials: I
authors.lastname: Chokyu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Ichinose
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Takami
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohata
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D005830:Geniculate Ganglion / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*