Transpetrosal approaches: importance of venous structure and complication avoidance

Tuna H., Deda H., SAVAŞ A.

Skull Base, cilt.11, sa.SUPPL. 1, ss.43, 2001 (Scopus) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 11 Sayı: SUPPL. 1
  • Basım Tarihi: 2001
  • Dergi Adı: Skull Base
  • Derginin Tarandığı İndeksler: Scopus
  • Sayfa Sayıları: ss.43
  • Ankara Üniversitesi Adresli: Evet

Özet

Transpetrosal approaches offer distinct advantages over traditional approaches to the petroclival area. The goal of this study was to avoid the venous complications of transpetrosal surgery. We report on 16 consecutive cases operated via transpetrosal approach at the University of Ankara, Turkey. Total surgical resection was achieved in 75% of cases, partial resection in 25%. The most common tumor was meningioma, which occurred in 7 patients of this series (44%). There were 4 deaths (25%). Two patients died because of venous infarct documented by cerebral CT scan; another patient died as a result of brain stem edema; and another patient died because of a pulmonary embolism. Complications occurred in 40% of patients. Two of the patients suffered some degree of venous infarction in the temporal lobe postoperatively, but in their last follow-up they had no permanent neurological deficit. We, and some other authors, have observed post-operative venous complications after transpetrosal approaches even when care was taken to preserve the vein of Labbé. With experience of previous venous complications, we did not sacrifice the superior petrosal sinus and its tributaries in the last 6 cases and had no venous complications. The tentorium is incised without sacrificing the superior petrosal sinus to connect the middle and posterior fossae. Transpetrosal surgery, in particular when venous structures were preserved, is a safe approach. We do not sacrifice the superior petrosal sinus unless it is unavoidable for sake of venous complications. We recommend looking for and preserving all venous structures during the transtemporal approaches. For preserving the venous structures, sharp dissection and less retraction are essential. Preservation is still the best way to reduce the venous complications in lateral cranial base approaches. We would like to highlight importance of venous complications related to transpetrosal approach and avoidance of complications.