The preauricular subtemporal approach for transcranial petrous apex tumors.

OBJECTIVE: To review our series of 51 patients with transcranial petrous apex tumors who were surgically managed through a preauricular subtemporal approach.

STUDY DESIGN: A retrospective analysis of patient medical records.

SETTING: Tertiary care academic medical center.

PATIENTS: All patients with transcranial petrous apex tumors who were surgically treated between July 1988 and July 2005 with a preauricular subtemporal approach.

INTERVENTION: The preauricular subtemporal approach with preservation of hearing was used in all 51 cases.

MAIN OUTCOME MEASURES: The degree of tumor resection and long-term results.

RESULTS: Total tumor resection was achieved in 45 patients, and tumor was left in the cavernous sinus in 6 cases. Magnetic resonance imaging surveillance revealed no recurrent tumor in 36 patients, stable residual disease in 5 cases, and regrowth of tumor in 10 individuals (mean follow-up, 8.8 yr).

DISCUSSION: The postauricular infratemporal fossa approach allows adequate exposure to the petrous apex but with the expense of conductive hearing deficit. The preauricular subtemporal approach allows wide access for transcranial petrous apex tumors with preservation of hearing. Tumor control using this approach was achieved in 41 (80%) of 51 of the patients in this series.