Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1996 October; 6(4): 237–248.
PMCID: PMC1656624

The System of the Modified Transcochlear Approaches to the Petroclival Area and the Prepontine Cistern


Between June 1986 and June 1993 46 different tumors (27 extradural and 19 intradural) located in the petroclival area and/or prepontine cistern have been operated on at The Gruppo Otologico Piacenza and the ENT Department of Bergamo, Italy using a modification of the transcochlear approach. Total tumor removal was obtained in all cases. Complications occurred in eight patients. One patient died due to infarction of the brain stem. The system of modified transcochlear approaches conceived for the removal of various intradural and extradural tumors is presented. This approach, together with its modifications, is the major operative access to the central skull base and clivus among a series of lateral approaches described in the literature. The basilar surgical technique (type A) and its modifications (types B, C, D) are described in detail, and five different, illustrative cases are presented. Indications, limits, results, and complications related to the approach are discussed.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (4.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • House WF, Hitselberger WE. The transcochlear approach to the skull base. Arch Otolaryngol. 1976 Jun;102(6):334–342. [PubMed]
  • Jenkins HA, Fisch U. The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle. Am J Otol. 1980 Oct;2(2):70–76. [PubMed]
  • Sekhar LN, Estonillo R. Transtemporal approach to the skull base: an anatomical study. Neurosurgery. 1986 Nov;19(5):799–808. [PubMed]
  • Pellet W, Cannoni M, Pech A. The widened transcochlear approach to jugular foramen tumors. J Neurosurg. 1988 Dec;69(6):887–894. [PubMed]
  • Horn KL, Hankinson HL, Erasmus MD, Beauparalant PA. The modified transcochlear approach to the cerebellopontine angle. Otolaryngol Head Neck Surg. 1991 Jan;104(1):37–41. [PubMed]
  • Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg. 1992 Apr;76(4):588–599. [PubMed]
  • Thedinger BA, Glasscock ME, 3rd, Cueva RA. Transcochlear transtentorial approach for removal of large cerebellopontine angle meningiomas. Am J Otol. 1992 Sep;13(5):408–415. [PubMed]
  • Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol. 1988 Aug;30(2):108–116. [PubMed]
  • Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery. 1988 Mar;22(3):510–517. [PubMed]
  • Samii M, Ammirati M. The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir (Wien) 1988;95(1-2):6–12. [PubMed]
  • Ammirati M, Samii M. Presigmoid sinus approach to petroclival meningiomas. Skull Base Surg. 1992;2(3):124–128. [PMC free article] [PubMed]
  • Canalis RF, Black K, Martin N, Becker D. Extended retrolabyrinthine transtentorial approach to petroclival lesions. Laryngoscope. 1991 Jan;101(1 Pt 1):6–13. [PubMed]
  • House WF, Hitselberger WE, Horn KL. The middle fossa transpetrous approach to the anterior-superior cerebellopontine angle. Am J Otol. 1986 Jan;7(1):1–4. [PubMed]
  • Arriaga MA, Brackmann DE, Hitselberger WE. Extended middle fossa resection of petroclival and cavernous sinus neoplasms. Laryngoscope. 1993 Jun;103(6):693–698. [PubMed]
  • Sanna M, Zini C, Gamoletti R, Frau N, Taibah AK, Russo A, Pasanisi E. Petrous bone cholesteatoma. Skull Base Surg. 1993;3(4):201–213. [PMC free article] [PubMed]
  • Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery. 1992 Nov;31(5):813–828. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers