{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:06:23Z","timestamp":1783775183032,"version":"3.55.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Various lesions occur in deep locations or at the skull base in pediatric patients and require skull base approaches for resection. Skull base surgery confers the advantages of improved line of sight, a wider operative corridor, and reduced brain retraction. The posterior petrosal approach provides simultaneous access to lesions in the posterior middle fossa and posterior fossa from the top of the clivus to the level of the jugular foramen. It allows visualization of the ventrolateral brainstem and may be combined with various other supra- and infratentorial approaches, thus giving the surgeon a wide array of access routes to the lesion.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors conducted a retrospective review of all cases involving pediatric patients undergoing a posterior petrosal approach, either alone or in combination with other cranial approaches. Preoperative and postoperative data were collected, including presentation, neurological examination, imaging findings, pathological condition, operative details, perioperative complications, and postoperative outcomes.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>There were 13 patients (6 female, 7 male) with a mean age of 12.6 years (range 14 months\u20139 years). The posterior petrosal was the sole skull base cranial approach in 4 patients, whereas the posterior petrosal was combined with 1 or more other cranial approaches in 9. A gross-total resection was achieved in 7 patients, subtotal resection in 5, and a biopsy was performed in 1. Complications occurred in 9 patients, including 7 new or worsened cranial neuropathies. There was no perioperative mortality.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Although infrequently used in pediatric neurosurgery, the posterior petrosal approach is a highly versatile approach that can access intra- and extraaxial pathology centered on the petrous bone. The authors believe that patient outcomes are directly related to the degree of experience using this approach. Therefore, if this approach is to be used, they recommend collaboration with a skull base neurosurgeon.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.4.peds08426","type":"journal-article","created":{"date-parts":[[2009,10,1]],"date-time":"2009-10-01T16:05:27Z","timestamp":1254413127000},"page":"353-362","source":"Crossref","is-referenced-by-count":33,"title":["The posterior petrosal approach: technique and applications in pediatric neurosurgery"],"prefix":"10.3171","volume":"4","author":[{"given":"Paul","family":"Klimo","sequence":"first","affiliation":[{"name":"88th Medical Group, Wright-Patterson Air Force Base, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Browd","sequence":"additional","affiliation":[{"name":"Children's Hospital & Regional Medical Center, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Pravdenkova","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Couldwell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion L.","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0040353","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","author":"Abdel Aziz","year":"2000"},{"key":"b2-0040353","series-title":"J Neurosurg","first-page":"87","article-title":"The petrosal approach for the total removal of giant retrochiasmatic craniopharyngiomas in children","volume":"106","author":"Al-Mefty","year":"2007"},{"key":"b3-0040353","series-title":"Acta Neurochir Suppl (Wien)","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/978-3-7091-9183-5_27","article-title":"The petrosal approach: indications, technique, and results","volume":"53","author":"al-Mefty","year":"1991"},{"key":"b4-0040353","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1227\/00006123-198803000-00010","article-title":"Petrosal approach for petroclival meningiomas","volume":"22","author":"Al-Mefty","year":"1988"},{"key":"b5-0040353","series-title":"Nippon Jibiinkoka Gakkai Kaiho","doi-asserted-by":"publisher","first-page":"893","DOI":"10.3950\/jibiinkoka.92.893","article-title":"[The size of the mastoid pneumatization and otitis media with effusion in children.]","volume":"92","author":"Aoki","year":"1989"},{"key":"b6-0040353","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3171\/jns.1994.81.1.0060","article-title":"The far lateral\/combined supra- and infratentorial approach. A human cadaveric prosection model for routes of access to the petroclival region and ventral brain stem","volume":"81","author":"Baldwin","year":"1994"},{"key":"b7-0040353","series-title":"Acta Otolaryngol","doi-asserted-by":"publisher","first-page":"410","DOI":"10.3109\/00016487509121344","article-title":"An extended approach through the middle cranial fossa to the internal auditory meatus and the cerebello-pontine angle","volume":"80","author":"Bochenek","year":"1975"},{"key":"b8-0040353","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1017\/S0022215100113349","article-title":"Size variation of mastoid air cell system in Indian people at different age groups: a radiographic planimetric study","volume":"104","author":"Chatterjee","year":"1990"},{"key":"b9-0040353","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1097\/00006123-200209000-00017","article-title":"Combined petrosal approach to petroclival meningiomas","volume":"51","author":"Cho","year":"2002"},{"key":"b10-0040353","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"460","DOI":"10.3171\/jns.1993.79.3.0460","article-title":"Cosmetic mastoidectomy for the combined supra\/infratentorial transtemporal approach. Technical note","volume":"79","author":"Couldwell","year":"1993"},{"key":"b11-0040353","series-title":"Ann Otol Rhinol Laryngol","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1177\/000348948609500407","article-title":"Postnatal growth of the human temporal bone. Implications for cochlear implants in children","volume":"95","author":"Eby","year":"1986"},{"issue":"2","key":"b12-0040353","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical management of petroclival meningiomas: factors determining the choice of approach","volume":"19","author":"Erkmen","year":"2005"},{"key":"b13-0040353","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"59","DOI":"10.2176\/nmc.21.59","article-title":"Total removal of clivus meningiomas and the operative results","volume":"21","author":"Hakuba","year":"1981"},{"key":"b14-0040353","series-title":"Neurol Med Chir (Tokyo)","first-page":"63","article-title":"Clivus meningioma: six cases of total removal","volume":"17","author":"Hakuba","year":"1977"},{"key":"b15-0040353","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3171\/jns.2000.93.1.0108","article-title":"Classification and quantification of the petrosal approach to the petroclival region","volume":"93","author":"Horgan","year":"2000"},{"key":"b16-0040353","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"660","DOI":"10.3171\/jns.2001.94.4.0660","article-title":"Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases","volume":"94","author":"Horgan","year":"2001"},{"key":"b17-0040353","series-title":"Otolaryngology","doi-asserted-by":"publisher","first-page":"ORL-770","DOI":"10.1177\/019459987808600522","article-title":"Surgery of the skull base: transcochlear approach to the petrous apex and clivus","volume":"86","author":"House","year":"1978"},{"key":"b18-0040353","series-title":"Neurosurgical Operative Atlas: Neuro-Oncology","first-page":"170","article-title":"Petrosal approach for resection of petroclival meningiomas","author":"Liu","year":"2006"},{"key":"b19-0040353","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.2176\/nmc.29.1004","article-title":"Clivus and apicopetroclivus meningiomas\u2014report of 24 cases","volume":"29","author":"Nishimura","year":"1989"},{"key":"b20-0040353","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1177\/088307388600100107","article-title":"Development of paranasal and mastoid sinuses: a computed tomographic pilot study","volume":"1","author":"O'Tuama","year":"1986"},{"issue":"6","key":"b21-0040353","series-title":"Neurosurg Focus","first-page":"e8","article-title":"Anatomy of the combined retrolabyrinthine-middle fossa craniotomy","volume":"14","author":"Oghalai","year":"2003"},{"issue":"2 Suppl 1","key":"b22-0040353","series-title":"Neurosurgery","first-page":"ONS53","article-title":"Posterior transpetrosal approach: less is more","volume":"60","author":"Sincoff","year":"2007"},{"key":"b23-0040353","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3171\/jns.1992.76.4.0588","article-title":"The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases","volume":"76","author":"Spetzler","year":"1992"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/4\/4\/article-p353.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/4\/4\/article-p353.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/4\/4\/article-p353.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T11:36:31Z","timestamp":1681558591000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/4\/4\/article-p353.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2009,10]]},"references-count":23,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2009.4.peds08426","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10]]}}}