Petrosal Approach

1. Thomas Bogale /Han Kyu Kim
Je Beom Hong, Jae Joon Lim, Kyung Gi Cho
Oct 12 ’ 2018
D e p a r t m e n t o f N e u r o s u r g e r y
CHA Bundang Medical Center,
Addis Ababa University

2. Outline
 INTRODUCTION
 PETROSAL APPROACHES
 TAILORED PETROSAL APPROACH
 TED SCALE
 ILLUSTRATIVE CASES
 CONCLUSION

3. Approaches to
petroclival
region
 Fronto-orbito-zygomatic
 Retrosigmoid
 Transpetrosal
Petroclival Region
The transpetrosal approach is
the most favorable
Transpetrosal
Fronto-orbito-zygomatic
Retrosigmoid

4. Transpetrosal Approaches to petroclival region
Cranial Nerve Fence
Retrosigmoid
Presigmoid
Tailored
Petrosal
Posterior approaches
 Retrosigmoid
 Presigmiod
Anterior approaches
Wide exposure
Safe tumor resection

5. Positioning, Skin incision & Craniotomy
Tailored Petrosal Approach

6.  Dissection of GSPN
 Exposure of the petros apex & Meatal plate
 Petros apex drilling
 Cochlear line
 Petrosectomy
 Tailoring
 Extension - the arcuate space
 Dural Opening
 Opening of the porous trigeminus
 Sectioning of the tentorium

7. Exposure of the petros apex and meatal plate
GSPN Dissection

8. Meatal Plane  Petros apex drilling

9. Cochlear line
Petros Apex Drilling
Petrosectomy

10. Tailoring
Extent of lesion
TS – small
Tm - medium
Tf – full tailoring
Petrosectomy

11. • Widening - The arcuate space
• Space found between the otic capsule and superior
petrosal sinus (SPS)
Extension
Widening this space- provides adequate exposure with operating freedom
En - no extension
Ec- transcrusal
El- translabyrinthine

12. Dural Incision
Arcuate space
Opening of the porous trigeminus
Sectioning of the tentorium

13. TmEnDs
KDH, F/45

14. TED scale for petrosectomy
Tailoring Extension Dural incision
Tf
Tm
Ts
En
Ec
El
Ds
Dt

15. postop
AYM, F/35
preop
TsEnDs
Ventral Pontine CM

16. preop. KDH, F/45
postop.
High Grade Brainstem Glioma (HGBSG)
TmEcDs

17. preop.
postop.
LOS, F/64
TfEcDt
Sphenopetroclival Meningioma

18. A total of 59 cases of petrosal
approaches done
25 petroclival meningiomas
17 trigeminal schwannomas
7 brainstem gliomas
12 giant vestibular schwannomas
5 chondrosarcomas
3 chordomas

19. Conclusions
• Tailored petrosal approach is a versatile approach
• Provides wide exposure for huge lesions spanning
from middle fossa to the posterior fossa.
• Useful for
–Various lesion
–Younger patients for whom more aggressive resection is
desired
• Safe resection and better functional outcome

20. Thank you