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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Tumor induced surgical anatomical variations of cranial nerves in anterior petrosal approach to petroclival lesions

Meeting Abstract

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  • Hamid Boghei-Razavi - Department of Neurosurgery, Clemens Hospital, Münster, Germany
  • Ryosuke Tomio - Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
  • Masahiro Toda - Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
  • Uta Schick - Department of Neurosurgery, Clemens Hospital, Münster, Germany
  • Takeshi Kawase - Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
  • Kazunari Yoshida - Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.15.04

doi: 10.3205/14dgnc209, urn:nbn:de:0183-14dgnc2092

Published: May 13, 2014

© 2014 Boghei-Razavi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Numerous surgical approaches have been devised to address the petroclival region. Kawase’s approach through the middle fossa is a well-described option for addressing cranial base lesions of the petroclival region. Datas about the variations of anatomical structures in different petroclival pathologies help the surgeon to perform such an approach more confidently.

Method: We reviewed retrospectively videos and operation and histological records of 40 petroclival tumors between Jan 2009 – September 2013 in which Kawase’s approach was performed. The anatomical variations of Cranial nerves IV–VI related to the tumor divided into different categories: superior lateral (SL), inferior lateral (IL), superior medial (SM), inferior medial (IM), encased (E). The datas were analyzed considering the different pathological subgroups (meningioma, epidermoid and schwannoma).

Results: In 41% of meningiomas, the trigeminal nerve is encased by the tumor. In 38% of meningioma the trigeminal nerve is in SL part of the tumor and in 20% in IL part of the tumor. In 38% of meningioma, trochlear nerve is encased by the tumor. Abducens nerve is not always visible (35%). In epidermoid and trigeminal or abducens nerve schwannoma the pathological nerve’s pattern is different from meningioma.

Conclusions: The pattern of cranial nerves IV-VI is various in different types of petroclival tumors. In meningioma tumor type (cavernous, upper clival, tentorial and petrous apex) is the most important predictor of nerve’s location.