Classification and quantification of the petrosal approach to the petroclival region

Michael A. Horgan, Gregory Anderson, Jordi X. Kellogg, Marc S. Schwartz, Sergey Spektor, Sean O. McMenomey, Johnny B. Delashaw

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Object. The petrosal approach to the petroclival region has been used by a variety of authors in various ways and the terminology has become quite confusing. A systematic assessment of the benefits and limitations of each approach is also lacking. The authors classify their approach to the middle and upper clivus, review the applications for each, and test their hypotheses on a cadaver model by using frameless stereotactic guidance. Methods. The petrosal approach to the upper and middle clivus is divided into four increasingly morbidity-producing steps: retrolabyrinthine, transcrusal (partial labyrinthectomy), transotic, and transcochlear approaches. Four latex-injected cadaveric heads (eight sides) underwent dissection in which frameless stereotactic guidance was used. An area of exposure 10 cm superficial to a central target (working area) was calculated. The area and length of clival exposure with each subsequent dissection was also calculated. The retrolabyrinthine approach spares hearing and facial function but provides for only a small window of upper clival exposure. The view afforded by what we have called the transcrusal approach provides for up to four times this exposure. The transotic and transcochlear procedures, although producing more morbidity, add little in terms of a larger clival window. However, with each step, the surgical freedom for manipulation of instruments increases. Conclusions. The petrosal approach to the upper and middle clivus is useful but should be used judiciously, because levels of morbidity can be high. The retrolabyrinthine approach has limited utility. For tumors without bone invasion, the transcrusal approach provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The transotic approach provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. Transcochlear exposure adds little in terms of intradural exposure and should be reserved for cases in which access to the petrous carotid artery is necessary.

Original languageEnglish (US)
Pages (from-to)108-112
Number of pages5
JournalJournal of Neurosurgery
Volume93
Issue number1
StatePublished - Jul 2000

Fingerprint

Posterior Cranial Fossa
Morbidity
Hearing
Dissection
Latex
Facial Nerve
Carotid Arteries
Cadaver
Terminology
Head
Bone and Bones
Neoplasms

Keywords

  • Meningioma
  • Petrosal approach
  • Skull base
  • Surgical approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Horgan, M. A., Anderson, G., Kellogg, J. X., Schwartz, M. S., Spektor, S., McMenomey, S. O., & Delashaw, J. B. (2000). Classification and quantification of the petrosal approach to the petroclival region. Journal of Neurosurgery, 93(1), 108-112.

Classification and quantification of the petrosal approach to the petroclival region. / Horgan, Michael A.; Anderson, Gregory; Kellogg, Jordi X.; Schwartz, Marc S.; Spektor, Sergey; McMenomey, Sean O.; Delashaw, Johnny B.

In: Journal of Neurosurgery, Vol. 93, No. 1, 07.2000, p. 108-112.

Research output: Contribution to journalArticle

Horgan, MA, Anderson, G, Kellogg, JX, Schwartz, MS, Spektor, S, McMenomey, SO & Delashaw, JB 2000, 'Classification and quantification of the petrosal approach to the petroclival region', Journal of Neurosurgery, vol. 93, no. 1, pp. 108-112.
Horgan MA, Anderson G, Kellogg JX, Schwartz MS, Spektor S, McMenomey SO et al. Classification and quantification of the petrosal approach to the petroclival region. Journal of Neurosurgery. 2000 Jul;93(1):108-112.
Horgan, Michael A. ; Anderson, Gregory ; Kellogg, Jordi X. ; Schwartz, Marc S. ; Spektor, Sergey ; McMenomey, Sean O. ; Delashaw, Johnny B. / Classification and quantification of the petrosal approach to the petroclival region. In: Journal of Neurosurgery. 2000 ; Vol. 93, No. 1. pp. 108-112.
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