Combined Retrolabyrinthine Middle Fossa Transtentorial Approach to Tumors of the Petroclival Region: Clinical Outcome and Hearing Preservation

Background: Here we review our recent experience with the combined retrolabyrinthine (RL) middle fossa (MF) transtentorial (TT) approach for tumors of the petrous apex region. This is an approach we typically employ for tumors of the upper petroclival region and cerebellopontine angle in patients with serviceable hearing. Methods: All patients undergoing retrolabyrinthine middle fossa transtentorial surgery from 2008–2011 were included. Results: There were nine patients in total; seven had a meningioma of the petroclival region, one had a trigeminal neuroma, and one had an epidermoid tumor. For the latter patient, the RL MF TT approach was chosen over a retrosigmoid approach because of the ventral extension of disease. Six out of nine patients had serviceable hearing postoperatively. Only one early death occurred, on day 5, following surgery. Conclusions: For patients with potentially salvageable hearing, the RL MF TT approach can be utilized for access to the CP angle, petrous apex, and clivus, offering more anterior and ventral access than the retrosigmoid approach through a shorter route, while allowing the possibility of hearing preservation not attainable with the translabyrinthine and transcochlear approaches.