Combined Subtemporal-Suboccipital Approaches
In order to reduce the considerable retractor pressure in subtemporaltranstentorial approaches (Schisano and Tovi 1962) and still ensure adequate view of the posterior aspect of the petrous bone, the dorsum sellae, and midline structures, a posterior subtemporal approach may be combined with unilateral craniectomy of the posterior cranial fossa (Naffziger 1928; Fay 1930; Verbrugghen 1952; Bonnal et al. 1964; Luyendijk 1976; Pertuiset 1974; Samii 1981; Symon 1982; Malis 1984; Mayberg and Symon 1986; Al Mefty et al. 1988). In this way the surgeon is able to make use of the advantages of both approaches and to include a third advantage in the planning, that of gaining additional space in the region of the petrous bone. In our opinion, this combination is the most suited approach to petroclivotentorial lesions (Samii et al. 1989). Problems relating to temporal lobe as well as the cerebellum, which we wanted to avoid, made us choose this combined approach, the greatest advantage of which is that the temporal retractor hardly has to be used. Increasing experience with this approach and growing motivation brought by good results Samii et al. (1989) have prompted us to describe this variant of the combined supra-infratentorial approach separately and to compare it to the conventional approach as a “Variant B”.
KeywordsMeningioma Xenon Dura Verse Cholesteatomas
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