Skip to main content
SpringerLink
Log in

Surgical Strategy in Modification of the Transpetrosal Approach to Avoid Postoperative Venous Complications: A Report of 74 Consecutive Cases

  • Conference paper
  • First Online:
Complications in Neurosurgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 130))

Abstract

Background: The transpetrosal approach is a complex skull base procedure with a high risk of complications, particularly caused by injury of the venous system. It is in part related to variability of blood outflow pathways and their distinctive patterns in each individual patient.

Objective: To evaluate outcomes and complications after skull base surgery with use of the petrosal approach modifications, which selection was based on the detailed preoperative assessment of venous drainage patterns.

Methods: Overall, 74 patients, who underwent surgery via the transpetrosal approach at our institution between 2000 and 2017, were included in this study. In all cases, the venous drainage pattern was assessed preoperatively and categorized according to the predominant blood outflow pathway into four types as previously suggested by Hacker: (1) sphenoparietal sinus (SpPrt), (2) sphenobasal vein (SpB), (3) sphenopetrosal sinus (SpPS), and (4) cortical. The blood outflow through the bridging petrosal vein and the vein of Labbé was also taken into consideration. In patients with SpPrt- and a cortical-type venous drainage, the transpetrosal approach was used in a standard way. In patients with SpB-type venous drainage, limited extradural anterior petrosectomy was combined with intradural anterior petrosectomy after dural opening, superior petrosal sinus transection, tentorial cutting, Meckel’s cave opening, and trigeminal nerve mobilization. In patients with SpPS-type venous drainage, after standard petrosectomy, dural opening, and tentorial cutting, SpPS ligation was done followed by 2-week interval before staged definitive tumor resection.

Results: Gross total, near-total, and subtotal resection of the lesion (meningioma, 48 cases; retrochiasmatic craniopharyngioma, 11 cases; brain stem cavernoma, 7 cases; other tumors, 8 cases) was achieved in 30 (40.5%), 24 (32.4%), and 20 (27.0%) patients, respectively. Postoperative complications that were possibly related to venous compromise were noted in 18 patients (24.3%), but neither one was major. Of these 18 patients, 9 were symptomatic, but all symptoms—aphasia (4 cases), seizures (2 cases), and confusion (3 cases)—fully resolved after conservative treatment. Overall, 13 patients, including 4 symptomatic, had signal changes on T2-weighted brain MRI, which were permanent only in 3 cases (all asymptomatic).

Conclusion: Our suggested surgical strategy can be applied to any type of the venous drainage pattern. Preoperative evaluation and intraoperative preservation of the blood outflow pathways are crucial means for safe and effective application of the transpetrosal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Hakuba A, Nishimura S, Inoue Y. Transpetrosal–transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol. 1985;24:405–15.

    Article  CAS  PubMed  Google Scholar 

  2. Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985;63:857–61.

    Article  CAS  PubMed  Google Scholar 

  3. Kawase T, Shiobara R, Toya S. Anterior transpetrosal–transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991;28:869–76.

    Article  CAS  PubMed  Google Scholar 

  4. Al-Mefty O, Ayoubi S, Kadri PA. The petrosal approach for the total removal of giant retrochiasmatic craniopharyngiomas in children. J Neurosurg. 2007;106(2 Suppl):87–92.

    PubMed  Google Scholar 

  5. Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery. 1988;22:510–7.

    Article  CAS  PubMed  Google Scholar 

  6. Bertalanffy H, Benes L, Miyazawa T, Alberti O, Siegel AM, Sure U. Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients. Neurosurg Rev. 2002;25:1–55.

    Article  PubMed  Google Scholar 

  7. Cho CW, Al-Mefty O. Combined petrosal approach to petroclival meningiomas. Neurosurgery. 2002;51:708–18.

    Article  PubMed  Google Scholar 

  8. Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus. 2005;19(2):E7.

    Article  PubMed  Google Scholar 

  9. François P, Ben Ismail M, Hamel O, Bataille B, Jan M, Velut S. Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas. Acta Neurochir (Wien). 2010;152:1321–9.

    Article  PubMed  Google Scholar 

  10. Gross BA, Dunn IF, Du R, Al-Mefty O. Petrosal approaches to brainstem cavernous malformations. Neurosurg Focus. 2012;33(2):E10.

    Article  PubMed  Google Scholar 

  11. Hauck EF, Barnett SL, White JA, Samson D. The presigmoid approach to anterolateral pontine cavernomas. J Neurosurg. 2010;113:701–8.

    Article  PubMed  Google Scholar 

  12. Ichinose T, Goto T, Morisako H, Takami T, Ohata K. Microroll retractor for surgical resection of brainstem cavernomas. World Neurosurg. 2010;73:520–2.

    Article  PubMed  Google Scholar 

  13. Ohue S, Fukushima T, Kumon Y, Ohnishi T, Friedman AH. Surgical management of brainstem cavernomas: selection of approaches and microsurgical techniques. Neurosurg Rev. 2010;33:315–24.

    Article  PubMed  Google Scholar 

  14. Oiwa Y, Nakai K, Masaki Y, Masuo O, Kuwata T, Moriwaki H, Itakura T. Presigmoid approach for cavernous angioma in the pons—technical note. Neurol Med Chir (Tokyo) 2002;42:91–98.

    Google Scholar 

  15. Saito N, Sasaki T, Chikui E, Yuyama R, Kirino T. Anterior transpetrosal approach for pontine cavernous angioma—case report. Neurol Med Chir (Tokyo). 2002;42:272–4.

    Article  PubMed  Google Scholar 

  16. Shimamoto Y, Kawase T, Sasaki H, Shiobara R, Yamada F. Anterior transpetrosal approach to the prepontine epidermoids. Skull Base Surg. 1999;9:75–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Inamasu J, Shiobara R, Kawase T, Kanzaki J. Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery: a report of two cases. Eur Arch Otorhinolaryngol. 2002;259:162–5.

    Article  PubMed  Google Scholar 

  18. Kaplan HA, Browder J. Importance of veins in partial cerebral lobectomy. J Neurosurg. 1974;41:360–6.

    Article  CAS  PubMed  Google Scholar 

  19. Krisht AF, Barrow DL, Al-Mefty O, Dawson R, Shengelala G, Bonner G. Venous anatomy of the vein of Labbé complex. In: Hakuba A, editor. Surgery of the intracranial venous system. New York: Springer; 1996. p. 36–42.

    Google Scholar 

  20. Leonetti JP, Reichman OH, Silberman SJ, Gruener G. Venous infarction following translabyrinthine access to the cerebellopontine angle. Am J Otol. 1994;15:723–7.

    CAS  PubMed  Google Scholar 

  21. Hacker H. Normal supratentorial veins and dural sinus. In: Newton TH, Potts DG, editors. Radiology of the skull and brain. Saint Louis: Mosby; 1974. p. 1851–77.

    Google Scholar 

  22. Garcia-Ibanez E, Garcia-Ibanez JL. Middle fossa vestibular neurectomy: a report of 373 cases. Otolaryngol Head Neck Surg. 1980;88:486–90.

    Article  CAS  PubMed  Google Scholar 

  23. Ohata K, Baba M. Anterior transpetrosal–transtentorial approach. In: Hakuba A, editor. Surgical anatomy of the skull base. Tokyo: Miwa Shoten; 1996. p. 77–107.

    Google Scholar 

  24. Immadoel Haq IB, Susilo IR, Goto T, Ohata K. Dural incision in the petrosal approach with preservation of the superior petrosal vein. J Neurosurg. 2016;124:1074–8.

    Article  Google Scholar 

  25. Savardekar AR, Goto T, Nagata T, Ishibashi K, Terakawa Y, Morisako H, Ohata K. Staged ‘intentional’ bridging vein ligation: a safe strategy in gaining wide access to skull base tumors. Acta Neurochir (Wien). 2014;156:671–9.

    Article  PubMed  Google Scholar 

  26. Al-Mefty O, Krisht A. The dangerous veins. In: Hakuba A, editor. Surgery of the intracranial venous system. New York: Springer; 1996. p. 338–45.

    Google Scholar 

  27. Guppy KH, Origitano TC, Reichman OH, Segal S. Venous drainage of the inferolateral temporal lobe in relationship to transtemporal/transtentorial approaches to the cranial base. Neurosurgery. 1997;41:615–20.

    CAS  PubMed  Google Scholar 

  28. Sakata K, Al-Mefty O, Yamamoto I. Venous consideration in petrosal approach: microsurgical anatomy of the temporal bridging vein. Neurosurgery. 2000;47:153–61.

    CAS  PubMed  Google Scholar 

  29. Al-Mefty O, Ayoubi S, Kadri PA. The petrosal approach for the resection of retrochiasmatic craniopharyngiomas. Neurosurgery. 2008;62(5 Suppl 2 Operative):ONS331–6.

    PubMed  Google Scholar 

  30. Koerbel A, Gharabaghi A, Safavi-Abbasi S, Samii A, Ebner FH, Samii M, Tatagiba M. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. Eur J Surg Oncol. 2009;35:773–9.

    Article  CAS  PubMed  Google Scholar 

  31. Koerbel A, Wolf SA, Kiss A. Peduncular hallucinosis after sacrifice of veins of the petrosal venous complex for trigeminal neuralgia. Acta Neurochir (Wien). 2007;149:831–3.

    Article  CAS  PubMed  Google Scholar 

  32. Masuoka J, Matsushima T, Hikita T, Inoue E. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J Clin Neurosci. 2009;16:1342–4.

    Article  PubMed  Google Scholar 

  33. Strauss C, Naraghi R, Bischoff B, Huk WJ, Romstöck J. Contralateral hearing loss as an effect of venous congestion at the ipsilateral inferior colliculus after microvascular decompression: report of a case. J Neurol Neurosurg Psychiatry. 2000;69:679–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Strauss C, Neu M, Bischoff B, Romstöck J. Clinical and neurophysiological observations after superior petrosal vein obstruction during surgery of the cerebellopontine angle: case report. Neurosurgery. 2001;48:1157–61.

    CAS  PubMed  Google Scholar 

  35. Hafez A, Nader R, Al-Mefty O. Preservation of the superior petrosal sinus during the petrosal approach. J Neurosurg. 2011;114:1294–8.

    Article  PubMed  Google Scholar 

  36. Gupta SK, Salunke P. Intradural anterior petrosectomy for petroclival meningiomas: a new surgical technique and results in 5 patients: technical note. J Neurosurg. 2012;117:1007–12.

    Article  PubMed  Google Scholar 

  37. Ichimura S, Yoshida K, Kagami H, Inaba M, Orii M, Kitamura Y, Saga I, Toda M. Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach—technical case report. Neurosurg Rev. 2012;35:609–14.

    Article  PubMed  Google Scholar 

  38. Shibao S, Toda M, Orii M, Fujiwara H, Yoshida K. Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach. J Neurosurg. 2016;124:432–9.

    Article  PubMed  Google Scholar 

  39. Nakase H, Shin Y, Nakagawa I, Kimura R, Sakaki T. Clinical features of postoperative cerebral venous infarction. Acta Neurochir (Wien). 2005;147:621–6.

    Article  CAS  PubMed  Google Scholar 

  40. Ohata K, Haque M, Morino M, Nagai K, Nishio A, Nishijima Y, Hakuba A. Occlusion of the sigmoid sinus after surgery via the presigmoidal–transpetrosal approach. J Neurosurg. 1998;89:575–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest Statement

The authors have no conflict of interest concerning the reported materials or methods.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Pree Nimmannitya, Takeo Goto, Atsufumi Nagahama, Yuta Tanoue, Yuzo Terakawa, Toshiyuki Kawashima, Hiroki Morisako & Kenji Ohata

  2. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

    Pree Nimmannitya

  3. Department of Neurosurgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan

    Yuzo Terakawa

Authors
  1. Pree Nimmannitya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeo Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsufumi Nagahama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuta Tanoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuzo Terakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshiyuki Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroki Morisako
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenji Ohata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenji Ohata .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, India

    Keki E. Turel

  2. Department of Neurosurgery, Tokyo Women’s Medical University, Adachi Medical Center, Tokyo, Japan

    Mikhail F. Chernov

  3. Department of Neurosurgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India

    Hrishikesh Sarkar

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Nimmannitya, P. et al. (2023). Surgical Strategy in Modification of the Transpetrosal Approach to Avoid Postoperative Venous Complications: A Report of 74 Consecutive Cases. In: Turel, K.E., Chernov, M.F., Sarkar, H. (eds) Complications in Neurosurgery. Acta Neurochirurgica Supplement, vol 130. Springer, Cham. https://doi.org/10.1007/978-3-030-12887-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-12887-6_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12886-9

  • Online ISBN: 978-3-030-12887-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation