Choice of the surgical approach to petroclival tumor

Objective To discuss the reasonable choice of the surgical approach to petroclvial tumors.Methods The clinical data of consecutive 53 patients with the petroclival tumors,treated from June 2002 to June 2004,were reviewed to compare the different surgical approaches to pertroclival region.Result Subtemporal transtentorial approach were used in 11 patients,suboccipital retrosigmoid approach in 12 patients,(transzygomatic or orbitozygomatic) frontotemporal(pterional) approach in 12 patients,presigmoid sinus approach in 2 patients,subtemporal and retrosigmoid sinus combined approach in 7 patients,subtemporal anterior petrosal extradural approach in 7 patients and extended transfrontal base extradural approach in 2 patients.Of all patients in this group,total tumor removal was achieved in 32 patients,subtotal in 9,largely partial in 12.The new cranial nerve deficit took place in 16 patients postoperatively,two patients died from coma and serious pneumonia.Conclusions Using perfect microsurgical technique,conventional surgical approaches on petroclival region such as suboccipital retrosigmoid approach,subtemproal transtentoiral approach can be suitable for most petroclival tumor with the help of neuro-navgation and neuroendoscope.To the epidural tumor on petroclival region,the epidural approach should be used with less invasion to the brain tissue.And to the giant petroclival tumor,the combinted-tentorial approach can provide an excellent access and exposure to the tumor.