title: Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study.
abstract: Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity. Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region. Methods The petroclival region was approached transclivally with EEA. Different aspects of dissection were compared with the posterior petrosal approach. The two approaches were also studied using CT analysis. Results A successful corridor medial to the internal auditory canal (IAC) was achieved with EEA. Wide exposure was achieved with no external skin incisions, although significant sinonasal resection was required. The posterior petrosal was comparable in terms of exposure medially; however, the dissection involved more bone removal, greater skill, and a constricting effect upon deeper dissection. Importantly, access lateral to the IAC was obtained, whereas EEA could not reach this area. Conclusion An EEA to the petroclival region is feasible. This approach can be considered in lesions medial to the IAC.
authors.affiliation: Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Mason
authors.affiliation: Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States.
authors.forename: Jason Van
authors.initials: JV
authors.lastname: Rompaey
authors.affiliation: Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States.
authors.forename: C Arturo
authors.initials: CA
authors.lastname: Solares
authors.affiliation: Department of Radiology, Georgia Regents University, Augusta, Georgia, United States.
authors.forename: Ramon
authors.initials: R
authors.lastname: Figueroa
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Prevedello
keywords: combined subtemporal retrolabyrinthine transpetrosal; cranial base; endonasal; endoscopic; petroclival region; posterior petrosal; skull base surgery