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Petrous bone lesions: surgical implementation and outcomes of extradural subtemporal approach

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Petrous bone lesions (PBLs) are rare with few reports in the neurosurgical literature. In this study, the authors describe our current technique of extradural subtemporal approach (ESTA). The objective of this study was to evaluate the role and efficacy of ESTA for treatment of the PBLs. To our knowledge, this is the largest reported clinical series of using an ESTA-treated PBLs in which the clinical outcomes were evaluated.

Methods

Between 1994 and 2019, 67 patients with PBLs treated by ESTA were retrospectively reviewed. Extent of resection, neurological outcomes, recurrence rate, and surgical complications were evaluated and compared with previous studies. The indications, advantages, limitations, and outcomes of ESTA were analyzed according to pathology.

Results

This series included 7 facial nerve schwannomas (10.4%), 16 cholesterol granulomas (23.9%), 16 chordomas (23.9%), 6 chondrosarcomas (9%), 5 trigeminal schwannomas (7.5%), 9 epidermoids/dermoids (13.4%), and 8 other pathologies (11.9%). The most common location of PBLs operated with ESTA was at the petrous apex and rhomboid areas (68.7%). Gross total resection was achieved in 35 (55.6%). Symptomatic improvement occurred in 56 patients (83.6%). Complications occurred in 7 (10.4%) of cases including one mortality. Nine patients (17%) had recurrence within the mean follow-up 71 months. Compared to previous literature, our results demonstrated comparable outcomes but with higher rates of hearing and facial nerve preservation as well as minimal morbidity. From our results, ESTA is an effective therapeutic option for lesions located at the rhomboid and petrous apex, particularly when patients presented with intact facial and hearing function.

Conclusion

Our series demonstrated that ESTA provided satisfactory outcomes with excellent benefits of hearing and facial function preservation for patients with petrous bone lesions. ESTA should be considered as a safe and effective therapeutic option for selected patients with PBLs.

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Abbreviations

AE:

Arcuate eminence

C6:

Petrous carotid artery

CN:

Cranial nerve

Co:

Cochlear

CPA:

Cerebellopontine angle

CSF:

Cerebrospinal fluid

ECA:

External carotid artery

EOR:

Extent of resection

ESTA:

Extradural subtemporal approach

FN:

Facial nerve

FNS:

Facial nerve schwannoma

GE:

Geniculate ganglion

GG:

Gasserian ganglion

GSPN:

Greater superficial petrosal nerve

GTR:

Gross total resection

HB Gr:

House–Brackmann grading

In:

Incus

IAC:

Internal auditory canal

ICA:

Internal carotid artery

ITFA:

Infratemporal fossa approach

LSC:

Lateral semicircular canal

Ma:

Malleolus

M2:

M2 segment of the middle cerebral artery

MMA:

Middle meningeal artery

NTR:

Near total resection

PAM:

Petrous apex meningocele

PBE:

Petrous bone epidermoid

PB:

Petrous bone

PBL:

Petrous bone lesion

PSC:

Posterior semicircular canal

PTA:

Pure tone audiometry

PTR:

Partial tumor resection

SDS:

Speech discrimination scores

SSC:

Superior semicircular canal

STA:

Superficial temporal artery

STR:

Subtotal tumor resection

SV:

Superior vestibular nerve

TgF:

Trigeminal fibrous ring

TS:

Trigeminal schwannoma

TTM:

Tensor tympani muscle

V2:

The maxillary division of trigeminal nerve

V3:

The mandibular division of trigeminal nerve

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Acknowledgements

For patient follow-up data, we express our gratitude to Drs. Tsutomu Masuda, Takuro Inoue, and Hiromi Goto. In addition, we would like to express our gratitude to Lori Radcliffe and James Carter, PA-C, for data collection and editorial assistance.

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Authors and Affiliations

  1. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Udom Bawornvaraporn, Ali R. Zomorodi, Allan H. Friedman & Takanori Fukushima

  2. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand

    Udom Bawornvaraporn

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Contributions

Conception and design: Udom, Fukushima. Acquisition of data: Udom, Fukushima. Analysis and interpretation of data: Udom. Drafting the article: Udom, Fukushima. Critically revising the article: Udom, Fukushima, Friedman, Zomorodi. Reviewed submitted version of manuscript: Udom, Fukushima, Friedman, Zomorodi. Approved the final version of the manuscript on behalf of all authors: Fukushima. Statistical analysis: Udom. Administrative/technical/material support: Udom. Study supervision: Fukushima.

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Correspondence to Udom Bawornvaraporn.

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Bawornvaraporn, U., Zomorodi, A.R., Friedman, A.H. et al. Petrous bone lesions: surgical implementation and outcomes of extradural subtemporal approach. Acta Neurochir 163, 2881–2894 (2021). https://doi.org/10.1007/s00701-021-04962-5

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