{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:43:21Z","timestamp":1792806201113,"version":"4.5.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The anterior transpetrosal approach (ATPA) was initially reported in 1985. The authors\u2019 institution has 274 case records of surgery performed with the ATPA during the period from 1984 to 2017. Although many technical advances and modifications in the ATPA have occurred over those 33 years, to the authors\u2019 knowledge no articles to date have reported a detailed analysis of variations and complications of the ATPA. In this study, the authors analyzed their patient series to elucidate improvements over time in ATPA methodology while highlighting unresolved problems and evaluating how to avoid surgical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>All surgical cases (274 patients) using the ATPA at the authors\u2019 institution during the period from 1984 to 2017 were analyzed retrospectively using charts, clinical summaries, operative records, and operative videos. Obtained parameters were patient age and sex, diagnosis, size of tumors, location of disease, operative date, neurological symptoms before and after surgery, radiographically identified brain injury, and other surgical complications. The most common diagnosis was petroclival meningioma (n = 158), followed by trigeminal schwannoma (n = 32), chordoma (n = 25), epidermoid tumor (n = 21), other tumor (n = 27), aneurysm (n = 6), and other (n = 5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The original ATPA was performed in 239 cases. In an additional 35 cases, a modified ATPA was performed. Zygomatic osteotomy with ATPA was a common modification that was used in 19 of the 35 cases to decrease retraction damage to the temporal lobe for high-positioned tumors. Brain injury by temporal lobe retraction without venous hemorrhage still occurred in 8 of the 19 cases (3.1%) with surgical death in 1 of these cases (0.4%) of reoperation with sacrifice of the petrosal vein. Symptomatic CSF leak was the most frequent complication noted and was observed in 35 cases (13.5%). In most of these cases the patients were cured by observation or lumbar drain, but in 6 cases (17.1%) reoperation was needed. Facial nerve damage related to surgical approach decreased from 6.2% to 3.5% after 2010; however, the incidence of CSF leaks (13.5%) has not improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>There have been several modifications and advancements made in the ATPA to increase tumor removal and decrease surgical complications. However, complications related to surgical approach occurred, such as venous occlusion\u2013related brain injury and facial nerve damage at pyramid resection. CSF leak remained an unsolved problem related to the ATPA procedures. Preoperative assessment of venous variation of the middle fossa, pneumatization of the temporal bone, and intraoperative monitoring of cranial nerves are important procedures to decrease these complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.12.jns204010","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T13:53:42Z","timestamp":1629467622000},"page":"413-421","source":"Crossref","is-referenced-by-count":35,"title":["Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications"],"prefix":"10.3171","volume":"136","author":[{"given":"Ryosuke","family":"Tomio","sequence":"first","affiliation":[{"name":"Department of Neurology and Brain Bank, Mihara Memorial Hospital, Gunma, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Horiguchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Borghei-Razavi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Kawase","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"r1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"857","DOI":"10.3171\/jns.1985.63.6.0857","article-title":"Transpetrosal approach for aneurysms of the lower basilar artery","volume":"63","author":"Kawase T","year":"1985","unstructured":"Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985;63(6):857\u2013861.405689910.3171\/jns.1985.63.6.0857"},{"issue":"4","key":"r2","series-title":"No Shinkei Geka","first-page":"304","article-title":"Anatomical and surgical note: anterior transpetrosal approach. Article in Japanese","volume":"26","author":"Kawase T","year":"1998","unstructured":"Kawase T. Anatomical and surgical note: anterior transpetrosal approach. Article in Japanese. No Shinkei Geka. 1998;26(4):304\u2013313.9592811"},{"issue":"6","key":"r3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1227\/00006123-199106000-00014","article-title":"Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients","volume":"28","author":"Kawase T","year":"1991","unstructured":"Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991;28(6):869\u2013876.206761110.1227\/00006123-199106000-00014"},{"key":"r4","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.clineuro.2015.10.032","article-title":"Anterior petrosal approach: the safety of Kawase triangle as an anatomical landmark for anterior petrosectomy in petroclival meningiomas","volume":"139","author":"Borghei-Razavi H","year":"2015","unstructured":"Borghei-Razavi H, Tomio R, Fereshtehnejad SM,  Anterior petrosal approach: the safety of Kawase triangle as an anatomical landmark for anterior petrosectomy in petroclival meningiomas. Clin Neurol Neurosurg. 2015;139:282\u2013287.2655203410.1016\/j.clineuro.2015.10.032"},{"issue":"1","key":"r5","series-title":"J Neurol Surg B Skull Base","first-page":"6","article-title":"Pathological location of cranial nerves in petroclival lesions: how to avoid their injury during anterior petrosal approach","volume":"77","author":"Borghei-Razavi H","year":"2016","unstructured":"Borghei-Razavi H, Tomio R, Fereshtehnejad SM,  Pathological location of cranial nerves in petroclival lesions: how to avoid their injury during anterior petrosal approach. J Neurol Surg B Skull Base. 2016;77(1):6\u201313.28035290"},{"issue":"6","key":"r6","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1016\/j.wneu.2014.06.034","article-title":"Approaches to upper basilar artery aneurysms","volume":"82","author":"Hernesniemi J","year":"2014","unstructured":"Hernesniemi J, Goehre F. Approaches to upper basilar artery aneurysms. World Neurosurg. 2014;82(6):1001\u20131002.2494711910.1016\/j.wneu.2014.06.034"},{"issue":"2","key":"r7","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1055\/s-2008-1058152","article-title":"Anterior transpetrosal approach to the prepontine epidermoids","volume":"9","author":"Shimamoto Y","year":"1999","unstructured":"Shimamoto Y, Kawase T, Sasaki H,  Anterior transpetrosal approach to the prepontine epidermoids. Skull Base Surg. 1999;9(2):75\u201380.10.1055\/s-2008-1058152"},{"issue":"6","key":"r8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.3171\/2012.9.JNS12429","article-title":"Intradural anterior petrosectomy for petroclival meningiomas: a new surgical technique and results in 5 patients: technical note","volume":"117","author":"Gupta SK","year":"2012","unstructured":"Gupta SK, Salunke P. Intradural anterior petrosectomy for petroclival meningiomas: a new surgical technique and results in 5 patients: technical note. J Neurosurg. 2012;117(6):1007\u20131012.10.3171\/2012.9.JNS1242923039146"},{"issue":"4","key":"r9","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s10143-016-0711-1","article-title":"Intradural anterior transpetrosal approach","volume":"39","author":"Ichimura S","year":"2016","unstructured":"Ichimura S, Hori S, Hecht N,  Intradural anterior transpetrosal approach. Neurosurg Rev. 2016;39(4):625\u2013631.10.1007\/s10143-016-0711-127041587"},{"issue":"3","key":"r10","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s10143-016-0719-6","article-title":"Anterior transpetrosal approach: epidural or subdural?","volume":"39","author":"Shibao S","year":"2016","unstructured":"Shibao S, Borghei-Razavi H, Yoshida K. Anterior transpetrosal approach: epidural or subdural? Neurosurg Rev. 2016;39(3):531\u2013534.10.1007\/s10143-016-0719-6"},{"issue":"2","key":"r11","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1016\/j.wneu.2015.03.055","article-title":"Anterior transpetrosal approach combined with partial posterior petrosectomy for petroclival meningiomas with posterior extension","volume":"84","author":"Shibao S","year":"2015","unstructured":"Shibao S, Borghei-Razavi H, Orii M, Yoshida K. Anterior transpetrosal approach combined with partial posterior petrosectomy for petroclival meningiomas with posterior extension. World Neurosurg. 2015;84(2):574\u2013579.10.1016\/j.wneu.2015.03.05525841755"},{"issue":"2","key":"r12","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s10143-010-0289-y","article-title":"Trigeminal schwannomas: experience with 57 cases and a review of the literature","volume":"34","author":"Fukaya R","year":"2010","unstructured":"Fukaya R, Yoshida K, Ohira T, Kawase T. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev. 2010;34(2):159\u2013171.10.1007\/s10143-010-0289-y"},{"issue":"4","key":"r13","series-title":"Keio J Med","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2302\/kjm.44.133","article-title":"Light up the \u201cno-man\u2019s land\u201d on the brain stem","volume":"44","author":"Kawase T","year":"1995","unstructured":"Kawase T. Light up the \u201cno-man\u2019s land\u201d on the brain stem. Keio J Med. 1995;44(4):133\u2013139.10.2302\/kjm.44.1338587225"},{"issue":"3 Suppl Operative","key":"r14","series-title":"Neurosurgery","first-page":"ons291","article-title":"Meckel\u2019s cave tumors: relation to the meninges and minimally invasive approaches for surgery: anatomic and clinical studies","volume":"67","author":"Muto J","year":"2010","unstructured":"Muto J, Kawase T, Yoshida K. Meckel\u2019s cave tumors: relation to the meninges and minimally invasive approaches for surgery: anatomic and clinical studies. Neurosurgery. 2010;67(3 Suppl Operative):ons291\u2013ons299."},{"issue":"2","key":"r15","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3171\/jns.1999.91.2.0202","article-title":"Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature","volume":"91","author":"Yoshida K","year":"1999","unstructured":"Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg. 1999;91(2):202\u2013211.10.3171\/jns.1999.91.2.020210433308"},{"issue":"7","key":"r16","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00701-010-0633-6","article-title":"Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years","volume":"152","author":"Seifert V","year":"2010","unstructured":"Seifert V. Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years. Acta Neurochir (Wien). 2010;152(7):1099\u20131116.10.1007\/s00701-010-0633-6"},{"issue":"5","key":"r17","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1227\/00006123-199211000-00001","article-title":"Microsurgical removal of petroclival meningiomas: a report of 33 patients","volume":"31","author":"Bricolo AP","year":"1992","unstructured":"Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery. 1992;31(5):813\u2013828.10.1227\/00006123-199211000-000011436406"},{"issue":"VideoSuppl2","key":"r18","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"V6","DOI":"10.3171\/2017.10.FocusVid.17343","article-title":"Combined petrosal approach for petroclival meningioma","volume":"43","author":"Arnaout O","year":"2017","unstructured":"Arnaout O, Al-Mefty O. Combined petrosal approach for petroclival meningioma. Neurosurg Focus. 2017;43(VideoSuppl2):V6.10.3171\/2017.10.FocusVid.1734328967316"},{"issue":"7","key":"r19","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s00701-008-1586-x","article-title":"Four subtypes of petroclival meningiomas: differences in symptoms and operative findings using the anterior transpetrosal approach","volume":"150","author":"Ichimura S","year":"2008","unstructured":"Ichimura S, Kawase T, Onozuka S,  Four subtypes of petroclival meningiomas: differences in symptoms and operative findings using the anterior transpetrosal approach. Acta Neurochir (Wien). 2008;150(7):637\u2013645.10.1007\/s00701-008-1586-x18548192"},{"key":"r20","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.wneu.2016.06.018","article-title":"The analysis of the petrosal vein to prevent venous complications during the anterior transpetrosal approach in the resection of petroclival meningioma","volume":"93","author":"Mizutani K","year":"2016","unstructured":"Mizutani K, Toda M, Yoshida K. The analysis of the petrosal vein to prevent venous complications during the anterior transpetrosal approach in the resection of petroclival meningioma. World Neurosurg. 2016;93:175\u2013182.2731239210.1016\/j.wneu.2016.06.018"},{"key":"r21","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"513.e19","DOI":"10.1016\/j.wneu.2015.09.030","article-title":"Encountering a basal vein of Rosenthal variant during the anterior transpetrosal approach","volume":"86","author":"Shibao S","year":"2016","unstructured":"Shibao S, Fujiwara H, Borghei-Razavi H, Yoshida K. Encountering a basal vein of Rosenthal variant during the anterior transpetrosal approach. World Neurosurg. 2016;86:513.e19\u2013e22.10.1016\/j.wneu.2015.09.03026409075"},{"issue":"2","key":"r22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"432","DOI":"10.3171\/2015.1.JNS141854","article-title":"Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach","volume":"124","author":"Shibao S","year":"2016","unstructured":"Shibao S, Toda M, Orii M,  Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach. J Neurosurg. 2016;124(2):432\u2013439.10.3171\/2015.1.JNS14185426314997"},{"issue":"1","key":"r23","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.wneu.2011.08.035","article-title":"Greater superficial petrosal nerve: a pole star to sail into the middle cranial fossa","volume":"77","author":"Tomasello FF","year":"2012","unstructured":"Tomasello FF, Angileri FF, Cardali S. Greater superficial petrosal nerve: a pole star to sail into the middle cranial fossa. World Neurosurg. 2012;77(1):78\u201379.10.1016\/j.wneu.2011.08.03522120291"},{"issue":"4","key":"r24","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1007\/s10143-010-0277-2","article-title":"Greater petrosal nerve schwannomas\u2014analysis of four cases and review of the literature","volume":"33","author":"Ichimura S","year":"2010","unstructured":"Ichimura S, Yoshida K, Sutiono AB,  Greater petrosal nerve schwannomas\u2014analysis of four cases and review of the literature. Neurosurg Rev. 2010;33(4):477\u2013482.10.1007\/s10143-010-0277-220668903"},{"issue":"10","key":"r25","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1007\/s00701-014-2162-1","article-title":"Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach","volume":"156","author":"Tomio R","year":"2014","unstructured":"Tomio R, Akiyama T, Ohira T,  Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach. Acta Neurochir (Wien). 2014;156(10):1847\u20131852.10.1007\/s00701-014-2162-124969175"},{"issue":"2","key":"r26","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"360","DOI":"10.3171\/2017.9.JNS171622","article-title":"Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach","volume":"130","author":"Tamura R","year":"2019","unstructured":"Tamura R, Tomio R, Mohammad F,  Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach. J Neurosurg. 2019;130(2):360\u2013367.10.3171\/2017.9.JNS171622"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/2\/article-p413.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/2\/article-p413.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/2\/article-p413.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:18:25Z","timestamp":1792804705000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/2\/article-p413.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":26,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2020.12.jns204010","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,1]]}}}