Surgical approaches for the treatment of petroclival tumors

Objective To investigate the surgical approaches for the treatment of petroclvial tumors in order to improve the surgical effect.Methods The clinical data of 92 patients with the petroclival tumors,treated from January 2000 to December 2009,were analyzed retrospectively to compare the effect of different surgical approaches for pertroclival tumors.According to the clinical features and imaging characteristics,92 cases with petroclival tumors were divided into four groups: subtemporal transtentorial approach was suggested for type Ⅰ petroclival tumors;subtemporal transpetrosal ridge approach for type Ⅱ tumors,including transpetrosal approach(combined supra-and infra-tentorial or presigmoid approach) for 3 cases with giant petroclival meningioma;suboccipital retrosigmoid approach for type Ⅲa tumors;suboccipital retrosigmoid suprameatal approach for type Ⅲb tumors and transsphenoidal approach for type Ⅳ tumors.Results Simpson I or Ⅱ resection was achieved in 83 cases.Simpson Ⅲ resection was achieved in 9 cases,including 1 case of type Ⅰ,5 cases of type Ⅱ,1 case of type Ⅲb and 2 cases of type Ⅳ.The new cranial nerve deficits occurred in 16 patients after the operation(17.4%),and transient hemiplegia was observed in 2 patients.Post-operative KPS of 50 was observed in 2 cases and was improved gradually during the 3 months' follow-up.No dead case occurred.Conclusion Suitable surgical approaches should be chosen according to different types of petroclival tumors,which is important to increase the therapeutic efficacy and decrease the postoperative complications.Suboccipital retrosigmoid,suboccipital retrosigmoid suprameatal approach and the modified approaches are the crucial surgical approaches for petroclival tumors.For the extradural tumors,the transsphenoidal approach is recommended.