Combined for Transpetrosal- Transtentorial Approach Excision of Petroclival Tumors Petroklival Tümörlerin Çikartilmasinda Kombine Transpetrozal Transtentorial Yaklasim

This report describes our experience using a combined transpetrosal-transtentorial approach to address petroelivallesions. This surgical technique provides good exposure to the cerebellopontine angle, the petroelival region, the posterior aspect of the cavernous sinus, and the upper and mid-clivus. Over a-5-year period, 16 patients with tumors in the petroelival region underwent surgery involving a combined transpetrosal-transtentorial approach. Eight of the masses were meningiomas, four were epidermoid eysts, three were trigeminal schwannomas, and one was a chordoma. Total resection of the tumor was achieved in 12 cases (75%), and subtotal resection in four cases (25%). Four patients died (25%) in the early postoperative period due to brainstem edema, hemorrhagic infarct, pulmonary embolism, and pulmonary dysfundion. The remaining 12 patients were followed for a mean of 30 months. Six patients developed additional neurological deficits postoperatively. None of the surviving 12 patients experienced tumor recurrence or symptomatic deterioration during follow-up. This technique provides the most efficient route to the petroelival region, offers good surgical exposure, allows the major cranial neurovascular structures to be preserved, minimizes temporallobe retraction, and does not impair hearing. In light of these advantages, we believe that the combined transpetrosal-transtentorial approach is the best way to access large tumors in the petroelival area. Key Word s: Meningioma, petroelivallesion, skull base surgery, transpetrosal-transtentorial approach