Presigmoid Approaches to Skull Base Lesions

  • M. T. Lawton
  • C. P. Daspit
  • R. F. Spetzler
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 23)


A critical component of many skull base approaches is the safe removal of the petrous bone (Brackmann et al. 1994, Baldwin et al. 1994, Spetzler et al. 1992, Sekhar et al. 1994, Al-Mefty et al. 1988, Hitselberger and House 1966, House 1979, Morrison and King 1973). Petrosectomy opens a corridor of exposure to the center of the skull base. The transpetrosal approaches include the retrolabyrinthine (Spetzler et al. 1994), translabyrinthine (Brackmann et al. 1992, House 1979, Morrison and King 1973), transcochlear (House and Hitselberger 1976), and middle fossa approaches (House and Shelton 1992, Brackmann et al. 1994). Still, exposure gained from these approaches can be limited medially at the region of interest or inadequate for larger lesions. Therefore, transpetrosal approaches have been used in combination with other approaches to gain even more exposure. For example, the combined supra- and infratentorial approach joins the sub temporal and transpetrosal exposures (Daspit et al. 1991, Spetzler et al. 1992, Spetzler et al. 1991, Hitselberger and House 1966) and the far-lateral combined supra- and infratentorial approach adds to them the far lateral exposure (Baldwin et al. 1994, Heros 1986, Sen and Sekhar 1990, Sen and Sekhar 1991, Spetzler and Grahm 1990b, Baldwin et al. 1995). We have continued to experiment with combination approaches, and one that has proven useful is the orbitozygomatic-combined supra- and infratentorial approach. This chapter reviews the surgical anatomy and techniques involved with the transpetrosal approaches, discusses the various combination approaches that use petrosectomy as their foundation, and identifies the current indications for these techniques.


Facial Nerve Semicircular Canal Sigmoid Sinus Facial Recess Skull Base Lesion 
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Copyright information

© Springer-Verlag Wien 1997

Authors and Affiliations

  • M. T. Lawton
    • 1
  • C. P. Daspit
    • 2
  • R. F. Spetzler
    • 1
  1. 1.Division of Neurological SurgeryBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA
  2. 2.Division of Neuro-OtologyBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA

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