J Neurol Surg B Skull Base 2016; 77(01): 006-013
DOI: 10.1055/s-0035-1555137
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pathological Location of Cranial Nerves in Petroclival Lesions: How to Avoid Their Injury during Anterior Petrosal Approach

Hamid Borghei-Razavi
1   Department of Neurosurgery, Clemens Hospital, Münster, Germany
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
,
Ryosuke Tomio
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
,
Seyed-Mohammad Fereshtehnejad
3   Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
,
Shunsuke Shibao
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
,
Uta Schick
1   Department of Neurosurgery, Clemens Hospital, Münster, Germany
,
Masahiro Toda
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
,
Kazunari Yoshida
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
,
Takeshi Kawase
2   Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

19 January 2015

03 May 2015

Publication Date:
19 June 2015 (online)

Abstract

Objectives Numerous surgical approaches have been developed to access the petroclival region. The Kawase approach, through the middle fossa, is a well-described option for addressing cranial base lesions of the petroclival region. Our aim was to gather data about the variation of cranial nerve locations in diverse petroclival pathologies and clarify the most common pathologic variations confirmed during the anterior petrosal approach.

Method A retrospective analysis was made of both videos and operative and histologic records of 40 petroclival tumors from January 2009 to September 2013 in which the Kawase approach was used. The anatomical variations of cranial nerves IV–VI related to the tumor were divided into several location categories: superior lateral (SL), inferior lateral (IL), superior medial (SM), inferior medial (IM), and encased (E). These data were then analyzed taking into consideration pathologic subgroups of meningioma, epidermoid, and schwannoma.

Results In 41% of meningiomas, the trigeminal nerve is encased by the tumor. In 38% of the meningiomas, the trigeminal nerve is in the SL part of the tumor, and it is in 20% of the IL portion of the tumor. In 38% of the meningiomas, the trochlear nerve is encased by the tumor. The abducens nerve is not always visible (35%). The pathologic nerve pattern differs from that of meningiomas for epidermoid and trigeminal schwannomas.

Conclusion The pattern of cranial nerves IV–VI is linked to the type of petroclival tumor. In a meningioma, tumor origin (cavernous, upper clival, tentorial, and petrous apex) is the most important predictor of the location of cranial nerves IV–VI. Classification of four subtypes of petroclival meningiomas using magnetic resonance imaging is very useful to predict the location of deviated cranial nerves IV–VI intraoperatively.