OBJECT: Although they provide excellent ventral and lateral exposure of the brainstem, petrosal approaches to brainstem cavernous malformations (CMs) are infrequently reported. METHODS: The authors reviewed their experience with petrosal approaches to brainstem CMs in combination with a comprehensive review of the literature to elucidate resection rates, complication rates, and outcomes. RESULTS: Including their own results, the authors found 65 cases in 20 reports of brainstem CMs treated with petrosal approaches. The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 case (2%). For 50 cases in 16 reports with detailed outcome information, the overall complete resection rate was 90%, with early postoperative morbidity reported in 30% of cases and permanent morbidity in 14%. The rate of CSF leakage was 6%. CONCLUSIONS: The versatile petrosal approaches to brainstem CMs are associated with good outcomes and an acceptable morbidity rate. More expansive lesions can be approached using a combination of the standard anterior and posterior petrosal approach, preserving hearing and avoiding the greater complication rates associated with extended posterior petrosal approaches.
OBJECT: Although they provide excellent ventral and lateral exposure of the brainstem, petrosal approaches to brainstem cavernous malformations (CMs) are infrequently reported. METHODS: The authors reviewed their experience with petrosal approaches to brainstem CMs in combination with a comprehensive review of the literature to elucidate resection rates, complication rates, and outcomes. RESULTS: Including their own results, the authors found 65 cases in 20 reports of brainstem CMs treated with petrosal approaches. The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 case (2%). For 50 cases in 16 reports with detailed outcome information, the overall complete resection rate was 90%, with early postoperative morbidity reported in 30% of cases and permanent morbidity in 14%. The rate of CSF leakage was 6%. CONCLUSIONS: The versatile petrosal approaches to brainstem CMs are associated with good outcomes and an acceptable morbidity rate. More expansive lesions can be approached using a combination of the standard anterior and posterior petrosal approach, preserving hearing and avoiding the greater complication rates associated with extended posterior petrosal approaches.
Authors: Pasquale Anania; Rosa Mirapeix-Lucas; Gianluigi Zona; Alessandro Prior; Carlos Asencio Cortes; Fernando Muñoz Hernandez Journal: J Neurol Surg B Skull Base Date: 2019-09-12
Authors: Christopher S Graffeo; Maria Peris-Celda; Avital Perry; Lucas P Carlstrom; Colin L W Driscoll; Michael J Link Journal: J Neurol Surg B Skull Base Date: 2019-10-28
Authors: Eduard H Voormolen; Sander Diederen; Helene Cebula; Peter A Woerdeman; Herke Jan Noordmans; Max A Viergever; Pierre A Robe; Sebastien Froelich; Luca Regli; Jan Willem Berkelbach van der Sprenkel Journal: Oper Neurosurg (Hagerstown) Date: 2020-01-01 Impact factor: 2.703