Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications

Abstract

Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear. This report details approach-related morbidity around and under the temporal lobe.

Methods A total of 46 consecutive patients identified from our surgical database were reviewed retrospectively.

Results Of the 46 patients, 61% were women. Median age of the patients was 50 years (mean: 48 ± 2 years). Median follow-up of this cohort was 66 months. Most procedures dealt with intradural pathology (n = 40 [87%]). Approach-related morbidity consisted of only two patients (4%) with new postoperative seizures. There were only two significant postoperative hemorrhages (4%). Cerebrospinal fluid leakage occurred in two patients (4%) requiring reoperation.

Conclusion Approach-related complications such as seizures and hematoma were infrequent in this series, < 4%. This report describes a contemporary group of patients treated with open AP and should serve as a comparison for approach-related morbidity of endoscopic approaches. Given the pathologies treated with this approach, the morbidity appears acceptable.

Keywords

anterior petrosectomy - morbidity - operative technique

• References

• 1 House WF. Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa. Laryngoscope 1961; 71: 1363-1385
• 2 House WF. Middle cranial fossa approach to the petrous pyramid. Report of 50 cases. Arch Otolaryngol 1963; 78: 460-469
• 3 House WF, Hitselberger WE, Horn KL. The middle fossa transpetrous approach to the anterior-superior cerebellopontine angle. Am J Otol 1986; 7 (1) 1-4
• 4 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 1991; 28 (6) 869-875 ; discussion 875–876
• 5 Friedman RA, Pensak ML, Tauber M, Tew Jr JM, van Loveren HR. Anterior petrosectomy approach to infraclinoidal basilar artery aneurysms: the emerging role of the neuro-otologist in multidisciplinary management of basilar artery aneurysms. Laryngoscope 1997; 107 (7) 977-983
• 6 Megerian CA, Chiocca EA, McKenna MJ, Harsh IV GF, Ojemann RG. The subtemporal-transpetrous approach for excision of petroclival tumors. Am J Otol 1996; 17 (5) 773-779
• 7 Slater PW, Welling DB, Goodman JH, Miner ME. Middle fossa transpetrosal approach for petroclival and brainstem tumors. Laryngoscope 1998; 108 (9) 1408-1412
• 8 Zhao JC, Liu JK. Transzygomatic extended middle fossa approach for upper petroclival skull base lesions. Neurosurg Focus 2008; 25 (6) E5 ; discussion E5
• 9 Barges-Coll J, Fernandez-Miranda JC, Prevedello DM , et al. Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies. Neurosurgery 2010; 67 (1) 144-154 ; discussion 154
• 10 Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 2010; 113 (5) 967-974
• 11 Mattox DE. Endoscopy-assisted surgery of the petrous apex. Otolaryngol Head Neck Surg 2004; 130 (2) 229-241
• 12 McLaughlin N, Kelly DF, Prevedello DM, Shahlaie K, Carrau RL, Kassam AB. Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma. J Neurol Surg B Skull Base 2012; 73 (3) 190-196
• 13 Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB. Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 2009; 119 (1) 19-25