Subtemporal transtentorial approach for excision of tumors in mid-superior petroclival region: a report of 43 cases

Objective To explore the surgical technique for excision of mid-superior petroclival region tumor through subtemporal transtentorial approach.Methods Forty-three patients with tumor at superior-middle petroclival region hospitalized from Jun.20003 to Apr.2010 were involved in present study,and their clinical data were retrospectively analyzed.Of the 43 patients,19 were male and 24 were female,age ranged from 23 to 64 years(with mean of 42 years),disease duration ranged from 2 months to 3 years(with average of 14 months).All the patients underwent tumor resection via subtemporal transtentorial approach.The relationship between tumors and adjacent superior-middle petroclival structures was evaluated,and then the adhesion between tumor and tentorium cerebelli or petroclival meninges was separated,the tumor was resected piecemeal from closest area to distant part.The arachnoidal planes between tumor and brain stem,hypothalamus,or cavernous was dissected to enlarge the gap between the tumor and brain tissue,at the same time avoiding irritation to the above important structures.The therapeutic effects and postoperative complications were recorded.Results Total resection was achieved in 31 cases(72.1%),subtotal resection in 7 cases(16.2%),and partial resection in 5 cases(11.6%).One patient died(3.3%).Twenty-three patients developed new postoperative neurological deficits.The patients were followed up for 3 to 48 months,and the neurological functions were found to recover in varying degrees.Conclusion Subtemporal transtentorial approach for excision of tumors at superior-middle petroclival region has advantages of shorter approach and easy to expose.The key of the operative procedure is to reduce the tumor volume and enlarge the operative space.