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Acta Neurochirurgica

, Volume 153, Issue 6, pp 1161–1167 | Cite as

How I do it: epidural anterior petrosectomy

  • Pierre-Hugues RocheEmail author
  • Vincent F. Lubrano
  • Rémy Noudel
How I Do It

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.

Keywords

Petrous bone Meningioma Skull base neoplasms Trigeminal ganglion Pons Clivus 

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

Notes

Conflicts of interest

None.

Supplementary material

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(MOV 8531 kb)

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Pierre-Hugues Roche
    • 1
    Email author
  • Vincent F. Lubrano
    • 2
  • Rémy Noudel
    • 1
  1. 1.Service de Neurochirurgie, CHU Marseille Nord, APHMUniversité de la MéditerrannéeMarseille Cedex 20France
  2. 2.Service de Neurochirurgie, CHU ToulouseUniversité de Toulouse-Paul SabatierToulouseFrance

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