Enlarged Entry Space for the Transpetrosal Approach

Abstract

An important consideration in neurosurgical procedures is avoiding retraction of the brain. Sindou and Fobe' reported on the usefulness of removing the roof of the external auditory meatus to avoid the excessive retraction of the temporal lobe or to prevent damage to the venous sinus and Labbe's vein while approaching the tentorial edge. this surgical approach is used for treatment at the tentorial notch, but in our surgical experience with cerebropontine angle lesions, it is also useful for posterior fossa lesions and upper clival lesions. In approaching acoustic neurinomas by the extended middle cranial fossa,24 we found this method to be useful in accessing not only a tentorial lesion but one situated lower than the tentorium. There has been some confusion about the extent of removal of the roof of the external auditory meatus. We report on the extent of bone removed in cadavers. METHODSWith a transtentorial transpetrosal approach to a lesion lower than the tentorium, the operative field is very deep and limited, but with a removal of the roof of the external auditory meatus, the entry zone is enlarged and the lesion is more easily accessible (Fig. 1). The 59 Skull Base Surgery, Volume 10, Number

Conquering the Rock—A Retrospective Single-Center Experience of the Transapical Petrosal Transtentorial (Kawase) Approach: Operative Technique and Impact on Cranial Nerve Function

“…Several reports show the benefit of skull base approaches for pathologies located in and around Meckel's cave, suggesting the benefit in terms of cranial nerve outcomes and extent of resection. 9,[21][22][23] Reports of the outcomes of the Kawase approach alone are scarce, as these are mostly reported together with other approaches for a particular indication. 9,21 The reported prevalence of CSF fistulas is 10.5%, 9 with 2.3% needing surgical repair.…”