The transpetrosal approach for cerebellopontine angle, petroclival and ventral brain stem lesions

Lesions at the cerebellopontine angle, the petroclival region and the ventral aspect of the brain stem are difficult to reach because of their deep seated location and the proximity and complexity of the functionally important surrounding anatomy. Resection of a portion of the petrous bone can provide a wide and direct exposure to these lesions. We employed this technique in the surgery for 39 patients harbouring these lesions which included 21 cerebellopontine angle tumours, nine petroclival tumours and nine ventral brain stem lesions. There was no surgical mortality and the most common morbities were facial nerve palsy (15%), lower cranial nerve palsy (15%) and trigeminal nerve dysfunction (10%). Total removal of tumour or vascular lesion was achieved in 33 patients (85%). Our results indicate that the transpetrosal approach can provide a satisfactory exposure of the cerebellopontine angle, the petroclival region and the ventral brain stem, minimizing the risk of surgical mortality and morbidity.