Neurosurgical strategies and operative results in the treatment of tumors of or extending to the petrous apex.

BACKGROUND: Tumors originating from or involving the petrous apex are considered to be an operative challenge due to their deep location and close relationship to critical neural and vascular structures. Extensive skull base approaches have been developed to deal with these lesions. The purpose of this study is to review an institutional series of 57 petrous apex tumors, to report our operative experiences and to address the usefulness and limits of standard approaches.

MATERIAL AND METHODS: 57 patients (22 men, 35 women) with petrous apex tumors were treated microsurgically. We analyzed the type of surgical approach, histological diagnoses, pre- and postoperative clinical findings, diagnostic imaging and surgery-associated complications.

RESULTS: According to the location and its predominant extension, a retromastoid approach (n=27), subtemporal approach (n=18), subtemporal/anterosigmoid approach (n=5), transnasal-transsphenoidal approach (n=2), pterional approach (n=2) or a subtemporal/retrosigmoid approach, biphasic approach (subtemporal and pterional), transmastoidal approach (n=1 each) was chosen. In the majority of cases, histological analysis revealed a meningeoma (n=31) or neurinoma (n=7). A total tumor resection was accomplished in 37 patients (64.9%). New permanent neurological deficits, mainly cranial nerve palsies, were found in 18 (31.6%), transient deficits in 5 patients (9.6%). Postoperative improvements of neurological deficits were observed in 17 patients (29.8%), and the neurological status remained unchanged in 17 patients (32.7%).

CONCLUSION: Complete resection of petrous apex tumors using standard neurosurgical approaches without permanent surgery-associated neurological deficits is achievable in the majority of cases.