The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area.

Jaejoon Lim,Kyunggi Cho

doi:10.1007/s11060-016-2061-9

Abstract

Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.Electronic supplementary materialThe online version of this article (doi:10.1007/s11060-016-2061-9) contains supplementary material, which is available to authorized users.

Highlights

Central skull base lesions in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) can be challenging for surgeons to access because of their position and relation to the brainstem
The mean operation time of patients with trigeminal schwannoma was significantly longer for the combined petrosal approach compared to the modified lateral supraorbital (MLSO) approach (801.7 vs. 379.3 min, respectively; p \ 0.001)
Gross total resection (GTR) was carried out for 18 of 27 patients (66.7 %) who received combined petrosal approach and 14 of 23 patients (60.9 %) who underwent the MLSO approach (p = 0.67); subtotal resection was performed for the remaining patients

Summary

Introduction

Central skull base lesions in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) can be challenging for surgeons to access because of their position and relation to the brainstem. Meningioma and trigeminal schwannoma are tumors that frequently occur in the petroclival area and the anterior CPA. These tumors are generated in narrow spaces and cause various symptoms by compressing the brainstem. Several approaches are used to remove such tumors, including petrosal approach, retrosigmoid approach, fronto-orbito-zygomatic approach and other combined approaches [1,2,3,4,5,6,7,8,9,10,11]. We present a series of 50 consecutive patients with tumors of the PCJ or anterior CPA who were treated surgically with the combined petrosal approach or MLSO approach. Compare the outcome of each approach, and evaluate the reliability and safety of the MLSO approach

Methods

Results

Conclusion