“Extended” Retrosigmoid Approach for Cerebellopontine Angle Tumors with Middle Fossa Extension

Background: Various transpetrosal approaches have been described for removal of tumors extending from the posterior fossa into middle fossa. However, these approaches are associated with significant morbidity and affect the quality of life. Material and Methods: Six patients with tumors extending across the petrous bone were operated by the “extended” retrosigmoid approach. Access to the supratentorial part of the tumors was enhanced by a tentorial incision (RSTT) in four cases and by anterior petrosectomy (RS+AP) in one. Results: Total excision was possible in five patients and subtotal in one. There was no approach-related complication in any patient. One patient had an infarct in the superior cerebellar artery territory. Apart from this, no patient had an added deficit and all continued to improve in the postoperative period. Conclusions: Aggressive transpetrosal approaches may not be necessary for many tumors of the petroclival region. An “extended” retrosigmoid approach with addition of a tentorial incision or a tailored anterior petrosectomy gives good exposure for tumor removal and is associated with minimal procedure-related complications.