COMBINED TRANSPETROSAL-SUBTEMPORAL CRANIOTOMY FOR CLIVAL TUMORS WITH EXTENSION INTO THE POSTERIOR-FOSSA

Tumors of the clivus, such as chordoma and chondrosarcoma, are general ly amenable to an anterior surgical approach. However, approaches that traverse the pharynx or paranasal sinuses do not adequately expose tu mor posterolateral to the horizontal course of the intrapetrous caroti d artery. In addition, when tumor extends into the posterior fossa, su pplemental exposure of neurovascular structures is necessary. A combin ation petrosectomy and subtemporal craniotomy can provide simultaneous access to the entire clivus as well as the lateral aspect of the midb rain, pens, and upper medulla. The extent of petrosectomy performed de pends on a number of factors including status of hearing, facial nerve function, and degree of brainstem compression. In our experience with three patients (two chordomas and one chondrosarcoma), using either t he retrolabyrin-thine-subtemporal or transcochlear-subtemporal approac h, excellent resection was achieved with acceptable morbidity consider ing the extensive nature of the disease.