Anterior Petrosal Approach: How and When Should It Be Done?

Objective: The management of tumors located in the petroclival junction has been widely discussed, and usually treated by posterior fossa or transpetrosal approaches. The anterior petrosal approach was described more than 30 years ago to access vascular pathology in the lower basilar artery. Since that time several modifications of the approach have been done to have a wider exposure of the upper clivus and the prepontine and interpeduncular cisterns. This approach has proven an important advantage when removing tumors invading the tentorium and Meckel´s cave. We present a series of cases where the anterior petrosal approach has proven and advantage to achieve a gross-total resection of the tumors

Methods: The authors retrospectively reviewed the operative notes of a consecutive database of procedures in which the anterior petrosal approach was performed. A CT and clinical correlation was done to achieve measurements of the posteromedial triangle of the middle fossa. An anatomical correlation was done to identify the limits, anteriorly the GSPN and the petrous carotid, laterally the IAC and the arcuate eminence, medially the trigeminal impression and posteriorly the petrous ridge. Opening the tentorium according to the need of each case allows versatility in this approach.

Result: Between January 2014 and August 2018, thirteen patients (3 males, 10 females) aged 15 to 72 years underwent a total of 13 anterior petrosal approach surgeries by the primary author (DMR). The most frequent treated histopathology was meningioma (n = 8). Multiple full HD videos are collected to analyze the surgical technique.

Conclusion: The anterior petrosal approach is an operative surgical technique which allows a surgical corridor for lesions in the petroclival region. This approach by itself or combined with other surgical techniques is essential component in the education of skull base surgeons.

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