Volume : VI, Issue : V, May - 2017

Surgical Management of Petroclival Lesions Quest for the Holy Grail !!

Maneet Gill, Amit Narang

Abstract :

 Background             Surgical management of petroclival regions remains particularly challenging for the neurosurgeon . This is so because the relative inaccessibility of this region surgically , the tenacious nature of  these lesions  and the presence of numerous critical neurovascular structures in this region. The pendulum of accepted wisdom keeps swinging between extensive total removal and maximal safe resection. We analysed our results to see what is optimal for such patients., what is the “ holy grail” in managing these patients surgically. Methods             All patients with clinical and radiological evidence of lesions involving the petroclival region operated  between 2009 and 2015  were included. Radiological evaluation was with contrast MRI.DSA was reserved for selected cases. Surgical approach was decided based on the size and exact disposition of the lesions. Results             There were 14 females and 09 males .Age range was 19 to 64 years.Clinical presentation included only headache(04),cranial nerve involvement(19),cerebellar signs(09),pyramidal  signs(08) and raised ICP(09). Surgical approach was decided on the exact location of the lesion.Surgical approaches used were anterior petrosal (06),posteriorpetrosal(09),combined petrosal(02),middlefossasubtemporal(05) and transpharyngeal with LeFort osteotomy(01).Total excision could be achieved in 14 patients and 09 had subtotal or partial excision. HPE revealed meningiomas(11),epidermoids(07),chordomas(03) and neurofioma(02). Conclusions             Petroclival lesions are typically difficult to manage surgically. With improving neurosurgical skull base techniques their management is improving, however they are still associated with significant morbidity due to involvement of lower cranial nerves. The current “holy grail” seems to achieve maximal safe resection without adding to the preoperative deficit of these patients.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Maneet Gill, Amit Narang, Surgical Management of Petroclival Lesions Quest for the Holy Grail !!, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : VOLUME-6 | Issue‾5 | May‾2017

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