[Combined supra and infratentorial presigmoideo approach for lesions of the petrous and clival regions]. / Abordaje combinado suprainfratentorial presigmoideo en las lesiones de la región petrosa y clival.

INTRODUCTION: Petrous and petroclival lesions may be surgically treated with combinations of suprainfratentorial presigmoideo approach and microsurgical techniques. OBJECTIVE: To demonstrate the utility and to present our surgical experiences with this approach. PATIENTS AND METHODS: Thirteen patients with lesions of the clival, petrous region and of the cerebellopontine angle with extension toward the anterior portion of brainstem were taken to the operative room. There were nine women and four men. Eleven were adults and two children. The main clinical manifestations were headache (100%), dysfunction of cranial nerves (90%), ataxia (90%) hemiparesis (75%). There was papiledema in 45%. Petroclival meningiomas and schwannomas were the more frequent lesions. There were three patients with intraxial brainstem tumors and two arteriovenous malformations. There were not aneurysms. We performed nine retrolaberintic, three translaberintic and one transcochlear approach. RESULTS: There was not severe incapacity, vegetative or dead patients. The surgical complications were facial nerve paresis (31%), cerebrospinal fluid leak (23%), decreased gag reflex (15%), abducens nerve paresis, hemiparesis and Claude Bernard Horner syndrome (8%). 50% of these complications disappeared three months later. CONCLUSIONS: The suprainfratentorial presigmoidal approach and their surgical variations could be utilized to obtaining a low morbimortality, in the treatment of different neoplasm and vascular diseases of the petrous and petroclival region.

Abordaje combinado suprainfratentorial presigmoideo en las lesiones de la región petrosa y clival / Combined supra-and infratentorial presigmoideo approach for lesions of the petrous and clival regions

Introducción. Las lesiones de la región petrosa y clival pueden intervenirse quirúrgicamente con la combinación del abordaje suprainfratentorial presigmoideo (ASITPS) y de las actuales técnicas microquirúrgicas. Objetivos. Demostrar la utilidad y presentar nuestras experiencias con este abordaje . Pacientes y métodos. Se llevaron al quirófano 13 pacientes con lesiones de la región clival, petrosa y del ángulo pontocerebeloso con extensión hacia la porción anterior del tronco. Hubo nueve mujeres y cuatro hombres; 11 eran adultos y dos niños. Las principales manifestaciones clínicas fueron la cefalea (100 por ciento), la disfunción de nervios craneales (90 por ciento), la ataxia (90 por ciento) y los déficit motores (75 por ciento). Hubo papiledema en el 45 por ciento. Los meningiomas petroclivales y los schwannomas fueron las lesiones más frecuentes. Hubo tres pacientes con neoplasias intraaxiales de tronco cerebral y dos malformaciones arteriovenosas. No hubo lesiones aneurismáticas. Realizamos nueve abordajes retrolaberínticos, tres translaberínticos y uno transcoclear. Resultados. No hubo pacientes gravemente incapacitados, vegetativos o fallecidos. Las complicaciones quirúrgicas fueron paresia facial periférica (31 por ciento), fístula de LCR (23 por ciento), reducción del reflejo de deglución (15 por ciento), paresia del nervio abducens (8 por ciento), hemiparesia y síndrome de Claude Bernard Horner (8 por ciento). El 50 por ciento de estas complicaciones desaparecieron en menos de tres meses. Conclusiones. El ASITPS y sus variantes quirúrgicas pueden utilizarse en el tratamiento quirúrgico de enfermedades tumorales y vasculares diversas de esa región y obtener una morbimortalidad baja (AU)

Introduction. Petrous and petroclival lesions may be surgically treated with combinations of suprainfratentorial presigmoideo approach and microsurgical techniques. Objectives, To demonstrate the utility and to present our surgical experiences with this approach. Patients and methods. Thirteen patients with lesions of the clival, petrous region and of the cerebellopontine angle with extension toward the anterior portion of brainsteam were taken to the operative room. There were nine women and four men. Eleven were adults and two children. The main clinical manifestations were headache (100%), dysfunction of cranial nerves (90%), ataxia (90%) hemiparesis (75%). There was papiledema in 45%. Petroclival meningiomas and schwannomas were the more frequent lesions. There were three patients with intraxial brainsteam tumors and two arteriovenous malformations. There were not aneurysms. We performed nine retrolaberintic, three translaberintic and one transcochlear approach. Results. There was not severe incapacity, vegetative or dead patients. The surgical complications were facial nerve paresis (31%), cerebrospinal fluid leak (23%), decreased gag reflex (15%), abducens nerve paresis, hemiparesis and Claude Bernard Horner syndrome (8%). 50% of these complications disappeared three months later. Conclusions. The suprainfratentorial presigmoidal approach and their surgical variations could be utilized to obtaining a low morbimortality, in the treatment of different neoplasm and vascular diseases of the petrous and petroclival region (AU