Name of the Procedure:

Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum, including ligation of superior petrosal sinus and/or sigmoid sinus.

Summary

This surgical procedure involves accessing the posterior cranial fossa, clivus, or foramen magnum through the petrous part of the temporal bone. It may require the ligation (tying off) of the superior petrosal sinus and/or sigmoid sinus to control bleeding and provide clear access to the surgical area.

Purpose

The transpetrosal approach is performed to treat brain tumors, vascular malformations, or other lesions located in the posterior part of the skull base. The goal is to safely remove or treat these abnormalities while minimizing damage to surrounding delicate structures.

Indications

• Tumors such as meningiomas, schwannomas, or chordomas in the posterior cranial fossa.
• Vascular malformations or aneurysms in the same region.
• Persistent or severe symptoms like headaches, dizziness, neurological deficits (e.g., hearing loss, facial numbness), or difficulty swallowing.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medication adjustments may be necessary, particularly concerning blood thinners.
• Pre-operation assessments could include MRI or CT scans, blood tests, and thorough neurological evaluations.

Procedure Description

• The patient is given general anesthesia.
• A precise incision is made near the petrous part of the temporal bone.
• Parts of the bone may be removed to create an access route to the posterior cranial fossa.
• The superior petrosal sinus and/or sigmoid sinus are identified and ligated to prevent bleeding.
• The targeted lesion or abnormality is then accessed and treated, which may involve tumor resection or vascular correction.
• The surgical site is carefully closed, and bone flaps are fixed back in place if removed.

Duration

The procedure typically takes between 4 to 10 hours, depending on the complexity of the case.

Setting

This surgery is performed in a hospital, specifically in an operating room equipped for neurosurgical procedures.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Possibly a neurotologist or other specialists, based on the complexity of the lesion.

Risks and Complications

• Common risks: Infection, bleeding, cerebrospinal fluid leakage, hearing loss.
• Rare risks: Stroke, brain injury, facial nerve damage, difficulty in balance and coordination.
• Complications are managed with appropriate medications, additional surgeries, and supportive care.

Benefits

• Effective removal or treatment of lesions in the posterior cranial fossa.
• Relief from symptoms such as pain, neurological impairments, and functional deficits.
• Recovery times and symptom relief vary but generally begin to improve within weeks to months post-surgery.

Recovery

• Patients will be monitored in the ICU immediately post-surgery.
• Pain management includes medications.
• Instructions are given for wound care, activity restrictions, and signs of complications.
• Follow-up appointments are essential for monitoring recovery and further treatments if needed.
• Physical therapy may be recommended to aid in full recovery.

Alternatives

• Non-surgical treatments, such as radiation therapy or chemotherapy, depending on the type of lesion.
• Less invasive surgical approaches or stereotactic radiosurgery (e.g. Gamma Knife).
• Each alternative has its own risks and benefits compared to the transpetrosal approach; effectiveness will depend on the specific condition being treated.

Patient Experience

The patient will be under general anesthesia and thus will not feel anything during the procedure. Post-surgery, discomfort or pain can be expected, for which pain relief measures will be provided. Initial recovery involves intensive monitoring and gradual return to normal activities over several weeks to months.