Petrous definition, noting or pertaining to the hard dense portion of the temporal bone, containing the internal auditory organs; petrosal. Frameless stereotactic navigation: This navigation aids surgical orientation, thus optimizing exposure and reducing risks, especially in complex approaches. An anterior temporal craniotomy is performed, followed by an orbitozygomatic osteotomy to extend the exposure of the conventional craniotomy anteriorly or inferiorly. What’s The Difference Between Atheism And Agnosticism? Meningiomas of the upper clivus may involve the cavernous sinus, sella turcica, Meckel’s cave, and tentorial notch; from the middle clivus, they may extend into the cerebellopontine angle; and meningiomas of the lower clivus may involve the jugular bulb, hypoglossal foramina, and upper cervical region. The fibers in the spinal tract and numerous collaterals end in a longitudinal cell column medial to the tract—the nucleus of the trigeminal spinal tract. Exposure of the lower clivus is limited by the jugular bulb, especially when it is high. The patient did not regain function after 1 year, however.25 Rocco and coworkers26 described a similar presentation of hearing loss and severe facial weakness (House-Brackmann grade IV) except that final pathology revealed a cavernous malformation in the IAC with hematoma formation into the CPA.26. They are rare and commonly encase the basilar artery and its branches. Absentee Ballot vs. Mail-In Ballot: Is There A Difference? 41-15 and 41-16). Variants include the partial labyrinthectomy petrous apicectomy approach,41,56 extended lateral subtemporal approach,38 and anterior subtemporal medial transpetrosal approach.42, The presigmoid translabyrinthine approach is an anterior extension of the presigmoid retrolabyrinthine approach. 14-6), which is used for lesions that arise on the upper two thirds of the clivus, such as petroclival meningiomas and chordomas. The mass of descending fibers constitutes the trigeminal spinal tract, situated underneath the lateral surface of the medulla oblongata and slightly deeper in the lower part of the pons. Various elaborate transpetrous approaches have been described, some of which involve mobilization of the facial nerve. In patients with neurofibromatosis type 2, a spine MRI should be performed because of possible associations with another central nervous system tumor. According to Yasargil et al.,2 these meningiomas may be attached “at any of the lateral sites along the petroclival borderline, where the sphenoidal, petrous and clival bones meet.” These authors suggested that such basal tumors can be divided into clival, petroclival, and sphenopetroclival, according to their points of insertion and extent. These meningiomas invade the posterior cavernous sinus and the sphenoid sinus and grow into the middle and posterior fossae.152, The classification of meningiomas of this area can also be based on the anatomic location of the tumor with reference to the clivus (i.e., upper, middle, or lower) and to the size and volume of the tumor (i.e., medium, up to 2.5 cm in average diameter; large, 2.5 to 4.5 cm; and giant, more than 4.5 cm).154. © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins The diagnosis of Gradenigo syndrome requires the demonstration of middle-ear infection. They are often sharply defined and enhanced compared with cholesteatomas and schwannomas.23 The presence of calcification within the lesion strongly suggests a hemangioma. Vascular embolization: Preoperative embolization of the external carotid artery feeders can be helpful in reducing intraoperative bleeding. The concept of restricting petrous bone removal to obtain the exposure necessary in individual cases has also been applied by several neurosurgeons.29,34,42,56,62. There are a number of approaches in which part of the petrous bone is removed. The approach involves the removal of the semicircular canals, thus enhancing the exposure. The location and volume of the tumor, its consistency and vascularity, the presence or absence of a subarachnoid plane between the meningioma and the brain stem, arterial and nervous displacement or encasement, and the correct choice of surgical approach are the factors that, ultimately, decide the extent of the surgical resection and the quality of the results. During this procedure, care should be taken not to damage the abducens nerve that runs through Dorello’s canal just medial to this area. 12,66,156-158 In these, the petrous part of the temporal bone is often removed to reduce retraction of the temporal lobe and cerebellum and to provide better exposure of … Radiosurgery: Such surgery can be helpful for treating small remnants in critical areas.

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