Abstract
Background
The anterior transpetrosal approach (ATPA) is a cranial base approach for addressing upper petroclival or lateral pontine lesions. It is fundamentally an epidural procedure involving the drilling of the petrous apex. However, this approach has significant procedure-related morbidity, and the surgeon must perform a complete petrosectomy, as the intradural structures are not in view during the drilling. For selected cases, a rationale exists for choosing a tailor-made intradural anterior petrosectomy (IAP).
Method
This article describes the relevant surgical anatomy and the different surgical steps of the IAP.
Conclusion
IAP represents a feasible alternative to the standard ATPA with the advantage of minimizing the extent of petrous bone removal to the individual need.
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Abbreviations
- ATPA :
-
Anterior transpetrosal approach
- IAP :
-
Intradural anterior petrosectomy
- CSF :
-
Cerebrospinal fluid
- MMA :
-
Middle meningeal artery
- GSPN :
-
Greater superior petrosal nerve
- V3 :
-
Mandibular nerve
- AE :
-
Arcuate eminence
- GG :
-
Geniculate nucleus
- SPS :
-
Superior petrosal sinus
References
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10 key points
• Preoperative preparation (location of the lesion; high-resolution imaging; neuronavigation; lumbar drainage)
• Supine lateral position with 90° head rotation. Older and heavy-set patients should be placed in a lateral position.
• Skin and soft tissue dissection
• Accurate subtemporal craniotomy as basal as possible
• Gentle retraction of the temporal lobe anterior to the Labbé vein
• Opening the ambient cistern and identification of the CN VI
• Identification of the petrous apex after probing the middle fossa floor postero-lateral to V3
• Tailor-made drill of the petrous apex
• Tentorial incision, SPS ligation, and posterior fossa dura opening
• Meticulous dural closure and bone replacement
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Boschi, A., Paggetti, F. & Vajkoczy, P. How I do it: intradural anterior petrosectomy. Acta Neurochir 165, 2957–2961 (2023). https://doi.org/10.1007/s00701-023-05683-7
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DOI: https://doi.org/10.1007/s00701-023-05683-7