Petrosal approach in management of petrous apex meningiomas and other petroclival tumors

Objectives: One of the varieties of postero-lateral approaches to petrous apex is petrosal approach. It is a combination of subtemporal and retrosigmoid accesses with partial petrosectomy, which is limited by facial nerve canal and labyrinth. We present immediate and late results of procedures, discuss benefits and limitations of this approach. Most important and requiring special attention procedure moments we consider: transverse and sigmoid sinus exposing, superior petrosal sinus ligation and transection (with vein of Labbé preservation), tentorium transection, cranial nerve and blood vessels identification and preparation, entrance into cavernous sinus region, dura closure and reconstruction of pyramid. Preoperative embolisation of feeding arteries is very helpful. Patients and methods: Since 1999 to 2004 we performed eleven such procedures. There were eight petroclival meningiomas, one epidermal cyst, one chondromyxoma, and one haemangiopericytoma in our group. During operation continuous monitoring of AEP, SEP and 3rd, 5th, 6th and 7th cranial nerves was performed. We present detailed analysis of neurological state in short and long postoperative period. Results: Total resection of the tumor was achieved in 8 cases and subtotal in 3 cases. There was no immediate postoperative mortality, one patient died on 10th day after operation due to pulmonary embolism. Conclusions: Petrosal approach enabled to successful removal of apex pyramid tumors with relatively low number of complications