Abstract
Background
Petrous bone lesions (PBLs) are rare with few reports in the neurosurgical literature. In this study, the authors describe our current technique of extradural subtemporal approach (ESTA). The objective of this study was to evaluate the role and efficacy of ESTA for treatment of the PBLs. To our knowledge, this is the largest reported clinical series of using an ESTA-treated PBLs in which the clinical outcomes were evaluated.
Methods
Between 1994 and 2019, 67 patients with PBLs treated by ESTA were retrospectively reviewed. Extent of resection, neurological outcomes, recurrence rate, and surgical complications were evaluated and compared with previous studies. The indications, advantages, limitations, and outcomes of ESTA were analyzed according to pathology.
Results
This series included 7 facial nerve schwannomas (10.4%), 16 cholesterol granulomas (23.9%), 16 chordomas (23.9%), 6 chondrosarcomas (9%), 5 trigeminal schwannomas (7.5%), 9 epidermoids/dermoids (13.4%), and 8 other pathologies (11.9%). The most common location of PBLs operated with ESTA was at the petrous apex and rhomboid areas (68.7%). Gross total resection was achieved in 35 (55.6%). Symptomatic improvement occurred in 56 patients (83.6%). Complications occurred in 7 (10.4%) of cases including one mortality. Nine patients (17%) had recurrence within the mean follow-up 71 months. Compared to previous literature, our results demonstrated comparable outcomes but with higher rates of hearing and facial nerve preservation as well as minimal morbidity. From our results, ESTA is an effective therapeutic option for lesions located at the rhomboid and petrous apex, particularly when patients presented with intact facial and hearing function.
Conclusion
Our series demonstrated that ESTA provided satisfactory outcomes with excellent benefits of hearing and facial function preservation for patients with petrous bone lesions. ESTA should be considered as a safe and effective therapeutic option for selected patients with PBLs.
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Abbreviations
- AE:
-
Arcuate eminence
- C6:
-
Petrous carotid artery
- CN:
-
Cranial nerve
- Co:
-
Cochlear
- CPA:
-
Cerebellopontine angle
- CSF:
-
Cerebrospinal fluid
- ECA:
-
External carotid artery
- EOR:
-
Extent of resection
- ESTA:
-
Extradural subtemporal approach
- FN:
-
Facial nerve
- FNS:
-
Facial nerve schwannoma
- GE:
-
Geniculate ganglion
- GG:
-
Gasserian ganglion
- GSPN:
-
Greater superficial petrosal nerve
- GTR:
-
Gross total resection
- HB Gr:
-
House–Brackmann grading
- In:
-
Incus
- IAC:
-
Internal auditory canal
- ICA:
-
Internal carotid artery
- ITFA:
-
Infratemporal fossa approach
- LSC:
-
Lateral semicircular canal
- Ma:
-
Malleolus
- M2:
-
M2 segment of the middle cerebral artery
- MMA:
-
Middle meningeal artery
- NTR:
-
Near total resection
- PAM:
-
Petrous apex meningocele
- PBE:
-
Petrous bone epidermoid
- PB:
-
Petrous bone
- PBL:
-
Petrous bone lesion
- PSC:
-
Posterior semicircular canal
- PTA:
-
Pure tone audiometry
- PTR:
-
Partial tumor resection
- SDS:
-
Speech discrimination scores
- SSC:
-
Superior semicircular canal
- STA:
-
Superficial temporal artery
- STR:
-
Subtotal tumor resection
- SV:
-
Superior vestibular nerve
- TgF:
-
Trigeminal fibrous ring
- TS:
-
Trigeminal schwannoma
- TTM:
-
Tensor tympani muscle
- V2:
-
The maxillary division of trigeminal nerve
- V3:
-
The mandibular division of trigeminal nerve
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Acknowledgements
For patient follow-up data, we express our gratitude to Drs. Tsutomu Masuda, Takuro Inoue, and Hiromi Goto. In addition, we would like to express our gratitude to Lori Radcliffe and James Carter, PA-C, for data collection and editorial assistance.
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Conception and design: Udom, Fukushima. Acquisition of data: Udom, Fukushima. Analysis and interpretation of data: Udom. Drafting the article: Udom, Fukushima. Critically revising the article: Udom, Fukushima, Friedman, Zomorodi. Reviewed submitted version of manuscript: Udom, Fukushima, Friedman, Zomorodi. Approved the final version of the manuscript on behalf of all authors: Fukushima. Statistical analysis: Udom. Administrative/technical/material support: Udom. Study supervision: Fukushima.
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Bawornvaraporn, U., Zomorodi, A.R., Friedman, A.H. et al. Petrous bone lesions: surgical implementation and outcomes of extradural subtemporal approach. Acta Neurochir 163, 2881–2894 (2021). https://doi.org/10.1007/s00701-021-04962-5
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DOI: https://doi.org/10.1007/s00701-021-04962-5