Computed tomography morphometric analysis of the central clival depression and petroclival angle for application of the presigmoid approach in the pediatric population.
OBJECTIVE
Lateral transtemporal approaches are useful for addressing lesions located ventral to the brainstem, especially when the pathologic diagnosis of the tumor dictates that a gross or near total resection improves outcomes. One approach, the presigmoid approach receives little attention in the pediatric population thus far. We sought to characterize morphometric changes, particularly the clival depth and the petroclival Cobb angle, that occur in the temporal bones of children and draw implications about doing a presigmoid approach in children.


METHODS
This study was a retrospective study performed at John Sealy Hospital, a level-one trauma center that takes care of pediatric injuries as well.


METHODS
We performed a morphometric analysis of noncontrast computed tomography head studies in 96 boys and 67 girls. Central clival depth and petroclival angle were obtained in the axial plane at the level of the internal auditory meatus using the method described by Abdel Aziz et al.


METHODS
Descriptive statistics and Student's t-test to compare groups were calculated using Microsoft Excel.


RESULTS
We found no gender difference in mean central clival depth or petroclival angle (P = 0.98 and P = 0.61, respectively). However, when we broke our cohort by age into those younger than 9 years of age and those 10 years or older, we found the petroclival angle decreased by 6.2° which was statistically significant (P < 0.000000006).


CONCLUSIONS
These findings suggest that a presigmoid retrolabyrinthine approach is useful for children 9 years of age and younger as the petroclival angle appears to decrease resulting in a shallower clival depression in these patients.
University of Texas Medical Branch, Galveston, TX, USA.
Sohum K
SK
Desai
University of Texas Medical Branch, Galveston, TX, USA.
Da'Marcus
D
Baymon
University of Texas Medical Branch, Galveston, TX, USA.
Eric
E
Sieloff
University of Texas Medical Branch, Galveston, TX, USA.
Kenneth
K
Maynard
Swedish Neuroscience Institute, Seattle, WA, USA.
Marc
M
Moisi
University of Texas Medical Branch, Galveston, TX, USA.
Achal P
AP
Patel
University of Texas Medical Branch, Galveston, TX, USA.
Joel T
JT
Patterson
Central clival depression; children; lateral skull base; presigmoid retrolabyrinthine approach