title: Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region.
abstract: OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. RESULTS Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. CONCLUSIONS The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.
authors: Departments of 1 Neurosurgical Surgery and.|Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
authors: Jun
authors: J
authors: Muto
authors: Departments of 1 Neurosurgical Surgery and.|Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and.
authors: Daniel M
authors: DM
authors: Prevedello
authors: Departments of 1 Neurosurgical Surgery and.
authors: Leo F S
authors: LF
authors: Ditzel Filho
authors: Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and.
authors: Ing Ping
authors: IP
authors: Tang
authors: Departments of 1 Neurosurgical Surgery and.
authors: Kenichi
authors: K
authors: Oyama
authors: Departments of 1 Neurosurgical Surgery and.
authors: Edward E
authors: EE
authors: Kerr
authors: Departments of 1 Neurosurgical Surgery and.|Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and.
authors: Bradley A
authors: BA
authors: Otto
authors: Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
authors: Takeshi
authors: T
authors: Kawase
authors: Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
authors: Kazunari
authors: K
authors: Yoshida
authors: Departments of 1 Neurosurgical Surgery and.|Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and.
authors: Ricardo L
authors: RL
authors: Carrau
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002102:Cadaver; D002784:Cholesterol; D002817:Chordoma / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D015745:Granuloma, Foreign-Body / Q000601:surgery; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose; D010579:Petrous Bone; D055815:Young Adult
chemical_list: D002784:Cholesterol
keywords: ATPA = anterior transpetrosal approach; CN = cranial nerve; EEA = endoscopic endonasal approach; GSPN = greater superficial petrosal nerve; ICA = internal carotid artery; SPS = superior petrosal sinus; anterior transpetrosal approach; cranial base; endoscopic endonasal approach; petroclival lesion; skull base