Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;163(10):2895-2907.
doi: 10.1007/s00701-021-04934-9. Epub 2021 Jul 27.

Neurosurgical management of petrous bone lesions: classification system and selection of surgical approaches

Udom Bawornvaraporn  1   2 , Ali R Zomorodi  3 , Allan H Friedman  3 , Takanori Fukushima  3
Affiliations

Neurosurgical management of petrous bone lesions: classification system and selection of surgical approaches

Udom Bawornvaraporn et al. Acta Neurochir (Wien). 2021 Oct.

Abstract

Background: Surgery of petrous bone lesions (PBLs) is challenging for neurosurgeons. Selection of the surgical approach is an important key for success. In this study, the authors present an anatomical classification for PBLs that has been used by our group for over the past 26 years. The objective of this study is to investigate the benefits and applicability of this classification.

Methods: Between 1994 and 2019, 117 patients treated for PBLs were retrospectively reviewed. Using the V3 and arcuate eminence as reference points, the petrous bone is segmented into 3 parts: petrous apex, rhomboid, and posterior. The pathological diagnoses, selection of the operative approach, and the extent of resection (EOR) were analyzed and correlated using this classification.

Results: This series included 22 facial nerve schwannomas (18.8%), 22 cholesterol granulomas (18.8%), 39 chordomas/chondrosarcomas (33.3%), 6 trigeminal schwannomas (5.1%), 13 epidermoids/dermoids (11.1%), and 15 other pathologies (12.8%). PBLs were most often involved with the petrous apex and rhomboid areas (46.2%). The extradural subtemporal approach (ESTA) was most frequently used (57.3%). Gross total resection was achieved in 58.4%. Symptomatic improvement occurred in 92 patients (78.6%). Our results demonstrated a correlation between this classification with each type of pathology (p < .001), selection of surgical approaches (p < 0.001), and EOR (p = 0.008). Chordoma/chondrosarcoma, redo operations, and lesions located medially were less likely to have total resection. Temporary complications occurred in 8 cases (6.8%), persistent morbidity in 5 cases (4.3%), and mortality in 1 case.

Conclusion: In this study, we proposed a simple classification of PBLs. Using landmarks on the superior petrosal surface, the petrous bone is divided into 3 parts, apex, rhomboid, and posterior. Our results demonstrated that chordoma/chondrosarcoma, redo operations, and lesions involving the tip of the petrous apex or far medial locations were more difficult to achieve total resection. This classification could help surgeons understand surgical anatomy framework, predict possible structures at risk, and select the most appropriate approach for each patient.

Keywords: Classification system; Extradural subtemporal approach; Middle fossa approach; Petrous bone lesion; Surgical approaches; Temporal bone.

PubMed Disclaimer

References

    1. Boari N, Gagliardi F, Cavalli A, Gemma M, Ferrari L, Riva P, Mortini P (2016) Skull base chordomas: clinical outcome in a consecutive series of 45 patients with long-term follow-up and evaluation of clinical and biological prognostic factors. J Neurosurg 125:450–460. https://doi.org/10.3171/2015.6.JNS142370 - DOI - PubMed
    1. Carlson ML, Deep NL, Patel NS, Lundy LB, Tombers NM, Lohse CM, Link MJ, Driscoll CL (2016) Facial nerve schwannomas: review of 80 Cases Over 25 Years at Mayo Clinic. Mayo Clin Proc 91:1563–1576. https://doi.org/10.1016/j.mayocp.2016.07.007 - DOI - PubMed
    1. Carlson ML, O’Connell BP, Breen JT, Wick CC, Driscoll CL, Haynes DS, Thompson RC, Isaacson B, Gidley PW, Kutz JW Jr, Van Gompel JJ, Wanna GB, Raza SM, DeMonte F, Barnett SL, Link MJ (2016) Petroclival chondrosarcoma: a multicenter review of 55 cases and new staging system. Otol Neurotol 37:940–950. https://doi.org/10.1097/MAO.0000000000001037 - DOI - PubMed
    1. Carlson ML, Osetinsky LM, Alon EE, Inwards CY, Lane JI, Moore EJ (2017) Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases. Laryngoscope 127:2340–2346. https://doi.org/10.1002/lary.26435 - DOI - PubMed
    1. Danesi G, Cooper T, Panciera DT, Manni V, Cote DW (2016) Sanna classification and prognosis of cholesteatoma of the petrous part of the temporal bone: a retrospective series of 81 patients. Otol Neurotol 37:787–792. https://doi.org/10.1097/MAO.0000000000000953 - DOI - PubMed

LinkOut - more resources