Abstract
Objective:
Although various surgical approaches are currently used to achieve access to petroclival meningiomas (PMs), each approach has an associated risk of postoperative deterioration of cochlear function. The purpose of this study is to review our experience with the partial translabyrinthine petrous apicectomy (PTLPA) approach to PM, as well as of the use of intraoperative brainstem auditory-evoked response (BAER) in PM as a predictive tool for auditory outcomes.
Design:
Retrospective case review over a 15-year period (1995 to 2010).
Setting:
Tertiary academic referral center.
Participants:
Patients with petroclival meningioma (PM) treated with partial translabyrinthine petrous apicectomy (PTLPA) with documented pre- and postoperative cochlear nerve assessment.
Main Outcome Measures:
Pre- and postoperative hearing function and intraoperative BAER.
Results:
Seventy-two PMs were treated surgically during the time period. Six patients underwent PTLPA. All were female. Five lesions were located on the right and one on the left. Mean age was 53 years. All patients had serviceable hearing preoperatively. All patients had subtotal resections via the PTLPA approach. Three patients (50%) maintained serviceable hearing postoperatively. Intraoperative BAER tracings were available in three cases. Two patients had significant decline in their wave V latencies intraoperatively. Of these two patients, one patient developed unserviceable hearing postoperatively, while the other retained serviceable hearing. The third patient had negligible changes in BAER tracings but unserviceable hearing postoperatively.
Conclusion:
The PTLPA approach for petroclival meningiomas is a useful tool in skull base surgery. It affords similar exposure to facilitate extirpation to its more ablative counterpart (e.g., translabyrinthine) while allowing for equal preservation of auditory function likened to the traditional approaches (e.g., retrosigmoid and retrolabyrinthine approaches) in which exposure may be inadequate. Our experience with intraoperative BAER tracings suggests that further experience with this tool is necessary to determine its predictive value for hearing conservation.