Transpetrosal approach for craniobasal tumors. Experience of 220 cases

Introduction: Since 1973, 220 transpetrosal approaches, for various craniobasal lesions in the CP angle, clivus and suprasellar areas, have been performed. Method: There were 127 female and 93 males with ages ranging between 2 and 73 years (mean 50.4 yrs). There are four kinds of transpetrosal approaches; 1) transmastoideal, 2) transzygomatic, 3) combined 1 and 2, 4) oticocondylar approaches. The selection of a particular approach will depend on the location and size of the lesion. Total removal of tumors in the transpetrosal approach was accomplished in 64% of 73 meningiomas, 95% of 64 neurinomas, 95% of 22 craniopharyngiomas, 74% of 19 pituitary adenomas and 73% of 11 chordomas. The outcome was excellent in 31, good in 167, poor in 10 and death in 12 with operative mortality 6 out of 220 (2.7%). Hearing was preserved 41% in 171. The complications were CSF leakage in 8, cerebral confusion in 18, infarction in 5, and meningitis in 6, etc. Discussion and Conclusion: The transpetrosal approach can be useful to minimize brain retraction and achieve optimal exposure with the shortest possible distance and the most adequate view angle in the suprasellar, clival and petroclival regions. In this approach, hearing may be preserved because the middle ear vestibule and cochlear can be left intact during removal of the petrous bone.