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How I do it: epidural anterior petrosectomy

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Abstract

Background

Among the potential approaches to access the petroclival area, epidural anterior petrosectomy (EAP) appears to be the most direct and conservative transpetrous route. In this article, we aim to detail the relevant surgical steps necessary to perform EAP in a reproducible and safe manner.

Method

The temporo-pterional bone flap is tailored to access the floor of the middle fossa and expose the foramen ovale and foramen spinosum. Elevation of the dura covering the upper surface of the petrous apex is conducted medially toward the level of the petrous ridge. Identification of the landmarks of the rhomboid fossa delineates the limits of the drilling zone (necessary for removal of the petrous apex)—beneath Meckel’s cave and just anterior to the anterior margin of the internal auditory meatus. The tentorium is divided at its free edge and is followed by opening of the posterior fossa dura.

Conclusion

Epidural anterior petrosectomy is a conservative trans-petrous approach that offers an excellent direct surgical corridor for exposure of disease processes involving Meckel’s cave, the petroclival area and the ventrolateral pons.

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Abbreviations

CSF:

Cerebrospinal fluid

EAP:

epidural anterior petrosectomy

GG:

geniculate ganglion

GSPN:

great superficial petrosal nerve

IPS:

inferior petrosal sinus

IAC:

internal auditory canal

SOF:

superior orbital fissure

SPS:

superior petrosal sinus

References

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Conflicts of interest

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Author information

Correspondence to Pierre-Hugues Roche.

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Roche, P., Lubrano, V.F. & Noudel, R. How I do it: epidural anterior petrosectomy. Acta Neurochir 153, 1161–1167 (2011). https://doi.org/10.1007/s00701-011-1010-9

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Keywords

  • Petrous bone
  • Meningioma
  • Skull base neoplasms
  • Trigeminal ganglion
  • Pons
  • Clivus