중앙 두개 기저부 종양에 대한 맞춤형 추체골 절제술

Tailored Combined Petrosectomy for Central Skull Base Tumors

Different combinations of anterior and posterior petrosal approaches can be proposed for central skull base tumors. We investigated the usefulness and limitations of combining various petrosal approaches. Six operations were performed in five patients who harbor the central skull base tumor. The patients included 4 females and 1 male, and the average age was 39.3 (range, 29-53) years. Four operations were performed via combined petrosal approach preserving the labyrinth, one was via the similar approach but sacrificing the labyrinth. We used a combined petrosal and temporopolar approach in a patient with recurrent meningioma invloving the petroclival area, posterior cavernous sinus and suprasellar areas. Fontopolar approach combined in that case made a direct vision from the suprasellar to the lower brainstem area. Furthermore, it could reduce morbidity associated with an upward retraction of the temporal lobe which needed to obtain a working space to remove the tumor extending to the suprasellar area via subtemporal avenue which was afforded by a petrosal approach. The anterior petrosal approach was more useful to reach the midline and/or contralateral petroclival junction. The posterior petrosal approach can provide good control of the cranial nerves, the brainstem and the vertebrobasilar artery which are displaced posteriorly by the tumor so they are susceptible to injury via the anterior approach. Retrosigmoid approach was combined in a patient whose tumor extended below the lower cranial nerves. Gross total resection was achieved in one, subtotal resection in three and partial resection in one patient. No operative death occurred. Combining various approaches according to the extent of tumor allows better visualization of the surrounding vital structures and more room for a safe removal. It is necessary to tailor various petrosectomy in the patient with a central skull base tumor.