The preauricular subtemporal approach for transcranial petrous apex tumors.

OBJECTIVE: To review our series of 51 patients with transcranial petrous apex tumors who were surgically managed through a preauricular subtemporal approach. STUDY DESIGN: A retrospective analysis of patient medical records. SETTING: Tertiary care academic medical center. PATIENTS: All patients with transcranial petrous apex tumors who were surgically treated between July 1988 and July 2005 with a preauricular subtemporal approach. INTERVENTION: The preauricular subtemporal approach with preservation of hearing was used in all 51 cases. MAIN OUTCOME MEASURES: The degree of tumor resection and long-term results. RESULTS: Total tumor resection was achieved in 45 patients, and tumor was left in the cavernous sinus in 6 cases. Magnetic resonance imaging surveillance revealed no recurrent tumor in 36 patients, stable residual disease in 5 cases, and regrowth of tumor in 10 individuals (mean follow-up, 8.8 yr). DISCUSSION: The postauricular infratemporal fossa approach allows adequate exposure to the petrous apex but with the expense of conductive hearing deficit. The preauricular subtemporal approach allows wide access for transcranial petrous apex tumors with preservation of hearing. Tumor control using this approach was achieved in 41 (80%) of 51 of the patients in this series.

Combined transtemporal access for large (>3 cm) meningiomas of the cerebellopontine angle.

OBJECTIVES: Large meningiomas of the cerebellopontine angle present a formidable surgical challenge due to tumor vascularity, neural attachment, and brain stem compression. The purpose of this paper is to present our use of the combined transtemporal approach in the surgical treatment of 29 large meningiomas. STUDY DESIGN AND SETTING: Twenty-nine patients with large meningiomas of the CPA were surgically treated through a combined retrosigmoid-transpetrosal-transcochlear approach at our tertiary care academic medical center from July 1995 through July 2004. Data was collected from a retrospective medical records review. RESULTS: Total tumor removal was achieved in 19 of 29 (67%) of the patients and the facial nerve was anatomically preserved in 26 of 29 (89%) of the cases. Cerebrospinal fluid leakage was seen in 3.5% of the patients and additional transient cranial nerve deficits were noted in 14% of the cases, but no significant neurologic sequelae occurred. Of the 10 patients with residual tumor, 6 have been stable without growth, 2 were treated with reoperation for regrowth of disease, and 2 were controlled with localized radiotherapy. CONCLUSIONS: This combined lateral transtemporal approach provided wide exposure to the cerebellopontine angle and optimized the surgical extirpation of 29 large meningiomas presented in this series. EBM RATING: C-4.