Combined petrosal approach

Purpose of review The combined petrosal approach to the lateral skull base merges a retrolabyrinthine-presigmoid posterior fossa craniotomy with an adjacent middle fossa craniotomy, which are rendered continuous by division of the tentorium. This is a hearing-preserving approach that affords wide access to the lateral aspect of the clivus, the prepontine space, and the cerebellopontine angle. Recent findings This article details the historical development of the combined petrosal approach alongside a description. In particular, the critically relevant anatomy is reviewed, including the course of the vein of Labbé, with a view toward avoiding the known complications associated with this approach. Outcomes for application of this approach as applied for various lesions are also reviewed as portrayed by the current literature. Summary The combined petrosal approach affords wide access to the lateral skull base in the middle and posterior fossa. The approach and the lesions addressed by this approach involve delicate and sensitive anatomy. We review the evolution of this approach and highlight advancements that have allowed the combined petrosal approach to be a safe addition to the surgeon's armamentarium.

[1]  K. Ohata,et al.  Safe Maximal Resection of Primary Cavernous Sinus Meningiomas via a Minimal Anterior and Posterior Combined Transpetrosal Approach , 2018, Journal of Neurological Surgery Part B: Skull Base.

[2]  J. Flickinger,et al.  Cranial nerve outcomes after primary stereotactic radiosurgery for symptomatic skull base meningiomas , 2018, Journal of Neuro-Oncology.

[3]  Min S. Park,et al.  Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance. , 2018, Neurosurgical focus.

[4]  Ai’jun Liang,et al.  Malignant Peripheral Nerve Sheath Tumor of the Trigeminal Nerve Involving the Middle and Posterior Cranial Fossa. , 2018, World neurosurgery.

[5]  K. Ohata,et al.  Contralateral Minimum Anterior and Posterior Combined Petrosal Approach for Retrochiasmatic Craniopharyngiomas: An Alternative Technique , 2018, Journal of Neurological Surgery Part B: Skull Base.

[6]  O. Arnaout,et al.  Combined petrosal approach for petroclival meningioma. , 2017, Neurosurgical focus.

[7]  Kazunari Yoshida,et al.  Anterior Transpetrosal Approach Combined with Partial Posterior Petrosectomy for Petroclival Meningiomas with Posterior Extension. , 2015, World neurosurgery.

[8]  P. Ferroli,et al.  The lateral infratrigeminal transpontine window to deep pontine lesions. , 2015, Journal of neurosurgery.

[9]  John Y. K. Lee,et al.  Gamma knife radiosurgery for cerebellopontine angle meningiomas: a multicenter study. , 2014, Neurosurgery.

[10]  K. Asaoka,et al.  Combined petrosal approach for resection of petroclival meningioma. , 2014, Neurosurgical focus.

[11]  T. Fukushima,et al.  The history of the combined supra- and infratentorial approach to the petroclival region. , 2012, Neurosurgical focus.

[12]  R. Du,et al.  Evolution of the posterior petrosal approach. , 2012, Neurosurgical focus.

[13]  R. Du,et al.  Petrosal approaches to posterior circulation aneurysms. , 2012, Neurosurgical focus.

[14]  C. Rosen,et al.  Microplate-Bridge Technique for Watertight Dural Closures in the Combined Petrosal Approach , 2012, Neurosurgery.

[15]  A. Friedman,et al.  Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas. , 2012, Journal of Neurosurgery.

[16]  A. Hafez,et al.  Preservation of the superior petrosal sinus during the petrosal approach. , 2011, Journal of neurosurgery.

[17]  D. Kondziolka,et al.  Long-term control of petroclival meningiomas through radiosurgery. , 2010, Journal of neurosurgery.

[18]  R. Spetzler,et al.  EVOLUTION OF SURGICAL APPROACHES IN THE TREATMENT OF PETROCLIVAL MENINGIOMAS: A RETROSPECTIVE REVIEW , 2007, Neurosurgery.

[19]  A. Morita,et al.  PETROCLIVAL MENINGIOMAS: MULTIMODALITY TREATMENT AND OUTCOMES AT LONG‐TERM FOLLOW‐UP , 2007 .

[20]  C. Shelton,et al.  Combined Petrosal Approaches in the Management of Temporal Bone Meningiomas , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[21]  K. Erkmen,et al.  Surgical management of petroclival meningiomas: factors determining the choice of approach. , 2005, Neurosurgical focus.

[22]  D. Brackmann,et al.  The Evolution of Surgical Approaches for Posterior Fossa Meningiomas , 2004, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[23]  O. Al-Mefty,et al.  Combined Petrosal Approach to Petroclival Meningiomas , 2002, Neurosurgery.

[24]  H. Coakham,et al.  Trochlear nerve schwannoma removed by combined petrosal approach , 2002, British journal of neurosurgery.

[25]  L. Sekhar,et al.  Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area. , 1999, Neurosurgery.

[26]  R. Jackler,et al.  The vulnerability of the vein of labbé during combined craniotomies of the middle and posterior fossae. , 1998, Skull base surgery.

[27]  T. Iwabuchi,et al.  Intraoperative recordings of evoked extraocular muscle activities to monitor ocular motor nerve function. , 1993, Neurosurgery.

[28]  R F Spetzler,et al.  The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. , 1992, Journal of neurosurgery.

[29]  A. Valavanis,et al.  The infratemporal fossa approach for the lateral skull base. , 1984, Otolaryngologic clinics of North America.

[30]  L. Frego,et al.  Ultrasonic aspiration in the surgical treatment of intracranial tumors. , 1981, Journal of neurosurgical sciences.

[31]  K. Tanaka,et al.  Clivus meningioma: six cases of total removal. , 1977, Neurologia medico-chirurgica.

[32]  T. King,et al.  Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. Technical note. , 1973, Journal of neurosurgery.

[33]  W. House,et al.  A combined approach to the cerebellopontine angle. A suboccipital-petrosal approach. , 1966, Archives of otolaryngology.

[34]  W. Hitselberger,et al.  TRANSTEMPORAL BONE MICROSURGICAL REMOVAL OF ACOUSTIC NEUROMAS. NEUROSURGICAL THOUGHTS COMPARING SUBOCCIPITAL AND TRANSLABYRINTHINE APPROACHES. , 1964, Archives of otolaryngology.

[35]  W. House.  Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa , 1961, The Laryngoscope.

[36]  J. Hunt,et al.  I. Contribution to the Surgery of Neurofibroma of the Acoustic Nerve: With Remarks on the Surgical Procedure. , 1904, Annals of surgery.

[37]  A. Gerster,et al.  A STUDY OF THREE CASES OF TUMOR OF THE BEAIN IN WHICH OPERATION WAS PERFORMED—ONE RECOVERY, TWO DEATHS , 1896 .