title: Intradural anterior transpetrosal approach.
abstract: The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages. Five patients with petroclival lesions underwent surgery via the intradural ATPA. The intraoperative hallmarks are detailed, and surgical results are reported. Total removal of the lesions was achieved in two patients with petroclival meningioma and two patients with pontine cavernoma, whereas subtotal removal was achieved in one patient with petroclival meningioma without significant morbidity. No patient experienced cerebrospinal fluid leakage. The intradural approach is allowed to tailor the extent of anterior petrosectomy to the individually required exposure, and the surgical procedure appeared to be more straightforward than via the epidural route. Caveats encountered with the approach were the temporal basal veins that could be spared as well as identification of the petrous apex due to the lack of familial epidural landmarks. The risk of injury to the temporal bridging veins is higher in this approach than in the epidural approach. Intradural approach is recommended in patients with a large epidural venous route, such as sphenobasal and sphenopetrosal vein. Navigation via bone-window computed tomography is useful to identify the petrous apex.
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of Neurosurgery, Shizuoka City Shimizu Hospital, 1231 Miyakase Shimizu-ku Shizuoka-city, 424-8636, Shizuoka, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Ichimura
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hori
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Hecht
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Czabanka
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. peter.vajkoczy@charite.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D000328:Adult; D002550:Cerebral Veins / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010579:Petrous Bone / Q000601:surgery; D011149:Pons / Q000473:pathology; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior transpetrosal approach; Intradural approach; Petrous apex; Sphenobasal vein; Sphenopetrosal vein; Subtemporal approach