Middle Skull Base Approach With Posterolateral Mobilization of the Geniculate Ganglion to Access the Clival Regions

Abstract

Clival lesions remain one of the most challenging intracranial tumors to treat surgically. Many skull base approaches have been described to improve resection and to decrease patient morbidity. To describe a middle skull base approach with posterolateral mobilization of the geniculate ganglion of the facial nerve to access the clival regions. Three patients with petroclival chordoma and 1 patient with petroclival meningioma underwent surgical resection of lesions with our new procedure. Surgical techniques consisted of temporal craniotomy and exposure of the facial nerve from the tympanic segment to the labyrinthine segment, keeping the fundus of the internal auditory canal intact. The geniculate ganglion was mobilized posterolaterally, followed by drilling of the cochlea and exposure of the Dorello canal. Four lesions were successfully removed with complete preservation of facial nerve function. This approach is a modification of the Goel procedure in which the facial nerve from the tympanic segment to the cisternal segment was totally mobilized. Our procedure carries less risk to the facial nerve function than the Goel procedure and provides sufficiently wide exposure of clival lesions.