Turkish Neurosurgery 2015 , Vol 25 , Num 1
Quantitative Anatomic Comparison of the Extended Pterional Transtemporal Transtentorial Approach and the Subtemporal Transtentorial Approach to the Petroclival Region
Yong TANG1, Han-Dong WANG1, Chi-Yuan MA1, Chao-Shuang ZHAN2, Xiang-Jun JI1, Lin ZHU1, Wei LI1, Wan-Chun YOU1, Hai-Ping LIN3, Wu-Zhao ZHONG3
1Nanjing University, School of Medicine, Jinling Hospital, Department of Neurosurgery, Nanjing, China
2Nanjing University, School of Medicine, Department of Anatomy, Nanjing, China
3Southern Medical University (Guangzhou), School of Medicine, Jinling Hospital, Department of Neurosurgery, Nanjing, China
DOI : 10.5137/1019-5149.JTN.7450-13.1 AIM: The anatomic characters and applicability of the extended pterional transtemporal transtentorial (EPTT) approach versus the subtemporal transtentorial (ST) approach for surgical treatment of petroclival tumors were evaluated.

MATERIAL and METHODS: Ten sides from five adult Chinese injected cadavers were manipulated using both two approaches. Four deep bony anatomic landmarks were specified in the skull base to create two adjoining triangles that were respectively located in the anterior and posterior petroclival region. The real, projected area and the percentage of the projected area were determined and calculated to compare the deep exposure from the two approaches.

RESULTS: There was no difference regarding the percentage of the projected area was calculated in the anterior triangles (EPTT, 21.5▒12.5%; ST, 28.8▒14.9%; p=0.1948), but a significant difference was present in the posterior triangles (EPTT, 74.0▒4.5%; ST, 51.5▒4.3%; p<0.01). Compared with the ST approach, the EPTT approach provides an equivalent percentage of projected area in the middle cranial fossa and a wider exposed area in the posterior cranial fossa.

CONCLUSION: Through anatomic comparative analysis the EPTT approach provides better exposure and is more appropriate than the ST approach for large and giant petroclival tumors predominantly in the posterior cranial fossa with extensive invasion to parasellar structures and the cavernous sinus. Keywords : Anatomic study, Petroclival region, Pterional approach, Subtemporal approach, Skull base

Corresponding author : Han-dong Wang, hdwang61@yahoo.com.cn