Surgical Treatment for Tumors in the Petroclival Area and Tentorium via Petrpsal Approach

Tumors of the basal posterior fossa, especially the clivus or petrous apex area, are embarrasing lesions because surgical access to these areas remains a formidable challenge.

Numerous approaches for lesions at this deep-seated and vital location, have been utiliged, but disappointed in resuts. The author consider that the petrosal approach is the most suitable for tumors located at these areas. The surgical technique of this approach is described and reviewed its advantages.

The author review the 14 harboring benign nature via the petrosal approach form September 1992 to February 1994.

There was no mortalily in this series. Total removal was achieved in 8 patients. Morbidity included hemiparsis(4 patients), cerebeller sings(3 patients), 7th cranial nerve deficit(1 patient) and persistent CSF leakage(1 patient).

The petrosal approach for the following advantages : the cerebellum and temporal lobes are minimally retracted, the operative distance to the clivus is shortened, the surgeon has a direct line of sight to the lesion and the anterior and lateral aspects of the brain stem, the neural and otological structures including the cochlea, the labyrinth and the facial nerves are preserved, the transveres and sigmoid sinuses as well as the vein of Labbe and the basal occipital veins are preserved, the tumour's blood supply is intercepted early in the procedure, multiple axes for dissection are provided, and dissection is performed along alongitudinal axis.

It is suggested that the petrosal approach is the most suitable for tumors of the basal posterior fossa(at the petrous apex or clivus).