{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:28:07Z","timestamp":1787682487326,"version":"build-2784847793"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The authors report on the anterior transpetrosal approach (ATPA) and the results of surgeries performed over a 33-year period for petroclival tumors, including meningioma, trigeminal schwannoma, chordoma, and epidermoid tumor. They analyze early postoperative neurological changes, surgical complications, and trends over the decades.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective analysis of 274 surgical cases that had undergone the ATPA from January 1984 to March 2017 was conducted. Data were collected from charts, clinical summaries, operative records, and operative videos. The analyzed parameters included patient diagnosis, tumor size, disease location, operation date, tumor removal rate, pre- and postoperative neurological symptoms (consciousness level, motor and sensory deficits of the limbs, sensory aphasia, and cranial nerve III\u2013VIII injuries), surgical deaths, and radiologically recognized brain injuries after the operation (contusion, infarction, hemorrhage).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Gross-total resection (GTR) was achieved in 53.5% of the 243 tumors with available data. The GTR rate for meningiomas (148 cases) was 54.1%. Trigeminal schwannomas had a high GTR rate of 87.1%, whereas chordomas had a low GTR rate of 14.3%.<\/jats:p>\n<jats:p>The rate of early neurological deterioration immediately after the ATPA, referred to as \"early neurological change,\" was as follows: consciousness disturbance in 1.9% of cases (5 cases), improvement of hemiparesis in 45.0% of cases but deterioration in 8.1% of cases, sensory aphasia in 2.3% of cases due to temporal lobe injury, improvement of cerebellar symptoms in 39.3% of cases with rare deterioration (1.9% of cases), worsening of preoperative diplopia in 49.4% of patients and rarely improving, improvement of trigeminal symptoms in 19.1% of cases (mostly trigeminal neuralgia) among the 43.7% of patients who had them preoperatively, and deterioration of facial hypesthesia and\/or paresthesia in 27.4% of cases.<\/jats:p>\n<jats:p>Early neurological deterioration was monitored in 183 patients for 6 months to determine the surgical complications of ATPA. Consciousness disturbance recovered in half of the cases but persisted in 3 (1.5%). Hemiparesis fully recovered in 63.2% of cases, resulting in a complication rate of 3.0%. The most frequent complication was diplopia (36.4%), with a complete remission rate of 26.4%. The second most frequent complication was facial hypesthesia (24.0%), with a recovery rate of 16.1%. Facial nerve palsy improved in 63.0% of cases and had a complication rate of 4.9%. Cerebellar symptoms showed complete recovery in all cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The ATPA allows the removal of petroclival tumors extending into Meckel\u2019s cave and the middle fossa, making it preferred for dumbbell trigeminal schwannomas and meningiomas. However, the ATPA\u2019s aggressive tumor removal can risk a lower recovery of cranial nerve IV\u2013VI deficits. For benign meningiomas, initial observation with regular follow-up is recommended. Surgery is appropriate for high-growth cases aiming for total removal, accompanied by a thorough explanation of the risks. If the risks are not accepted, subtotal removal can be considered, and radiosurgery is suggested for residual tumor.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.11.jns231532","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T01:18:54Z","timestamp":1706318334000},"page":"108-116","source":"Crossref","is-referenced-by-count":10,"title":["Anterior transpetrosal approach and the tumor removal rate, postoperative neurological changes, and complications: experience in 274 cases over 33 years"],"prefix":"10.3171","volume":"141","author":[{"given":"Ryosuke","family":"Tomio","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Honjo Neurosurgery and Spine Surgery Clinic, Saitama, 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":"Shunsuke","family":"Shibao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Ashikaga Hospital, Totigi, Japan"}],"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":"2","key":"b1","first-page":"173","article-title":"A modified extended middle cranial fossa approach for acoustic tumors. Article in Japanese","volume":"20","author":"Shiobara R","year":"1980","unstructured":"Shiobara R. A modified extended middle cranial fossa approach for acoustic tumors. Article in Japanese. Neurol Med Chir (Tokyo). 1980;20(2):173\u2013182."},{"issue":"6","key":"b2","series-title":"Neurosurgery","first-page":"869","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."},{"issue":"6","key":"b3","series-title":"J Neurosurg","first-page":"857","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."},{"issue":"3-4","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"113","article-title":"Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality","volume":"129","author":"Kawase T","year":"1994","unstructured":"Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir (Wien). 1994;129(3-4):113\u2013120."},{"issue":"2","key":"b5","series-title":"J Neurosurg","first-page":"413","article-title":"Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications","volume":"136","author":"Tomio R","year":"2021","unstructured":"Tomio R, Horiguchi T, Borghei-Razavi H, Tamura R, Yoshida K, Kawase T. Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications. J Neurosurg. 2021;136(2):413\u2013421."},{"issue":"1","key":"b6","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","author":"Abdel Aziz KM","year":"2000","unstructured":"Abdel Aziz KM, Sanan A, van Loveren HR, Tew JM Jr, Keller JT, Pensak ML. Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery. 2000;47(1):139\u2013152."},{"issue":"5","key":"b7","series-title":"Neurol India","first-page":"1434","article-title":"Surgical excision of large-to-giant petroclival meningiomas focusing on the middle fossa approaches: the lessons learnt","volume":"66","author":"Gosal JS","year":"2018","unstructured":"Gosal JS, Behari S, Joseph J,  Surgical excision of large-to-giant petroclival meningiomas focusing on the middle fossa approaches: the lessons learnt. Neurol India. 2018;66(5):1434\u20131446."},{"issue":"1","key":"b8","series-title":"Br J Neurosurg","first-page":"78","article-title":"Large and giant petroclival meningiomas: therapeutic strategy and the choice of microsurgical approaches - report of the experience with 41 cases","volume":"25","author":"Yang J","year":"2011","unstructured":"Yang J, Fang T, Ma S,  Large and giant petroclival meningiomas: therapeutic strategy and the choice of microsurgical approaches - report of the experience with 41 cases. Br J Neurosurg. 2011;25(1):78\u201385."},{"issue":"5","key":"b9","series-title":"Skull Base","first-page":"337","article-title":"Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era","volume":"20","author":"Diluna ML","year":"2010","unstructured":"Diluna ML, Bulsara KR. Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era. Skull Base. 2010;20(5):337\u2013342."},{"issue":"1","key":"b10","series-title":"Asian J Neurosurg","first-page":"188","article-title":"The retrosigmoid approach: workhorse for petroclival meningioma surgery","volume":"14","author":"Singh N","year":"2019","unstructured":"Singh N, Singh DK, Ahmad F, Kumar R. The retrosigmoid approach: workhorse for petroclival meningioma surgery. Asian J Neurosurg. 2019;14(1):188\u2013192."},{"issue":"6","key":"b11","series-title":"World Neurosurg","first-page":"1708","article-title":"Endoscopic-assisted posterior intradural petrous apitectomy in petroclival meningiomas: a clinical series and assessment of preoperative morbidity","volume":"84","author":"Tatagiba M","year":"2015","unstructured":"Tatagiba M, Rigante L, Mesquita Filho P, Ebner FH, Roser F. Endoscopic-assisted posterior intradural petrous apitectomy in petroclival meningiomas: a clinical series and assessment of preoperative morbidity. World Neurosurg. 2015;84(6):1708\u20131718."},{"issue":"1","key":"b12","series-title":"J Neurosurg","first-page":"40","article-title":"True petroclival meningiomas: results of surgical management","volume":"120","author":"Almefty R","year":"2014","unstructured":"Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O. True petroclival meningiomas: results of surgical management. J Neurosurg. 2014;120(1):40\u201351."},{"key":"b13","series-title":"World Neurosurg","first-page":"111","article-title":"True petroclival meningiomas: proposal of classification and role of the combined supra-infratentorial presigmoid retrolabyrinthine approach","volume":"96","author":"Sassun TE","year":"2016","unstructured":"Sassun TE, Ruggeri AG, Delfini R. True petroclival meningiomas: proposal of classification and role of the combined supra-infratentorial presigmoid retrolabyrinthine approach. World Neurosurg. 2016;96:111\u2013123."},{"issue":"2-3","key":"b14","series-title":"Neurochirurgie","first-page":"55","article-title":"Long term surgical results of 154 petroclival meningiomas: a retrospective multicenter study","volume":"65","author":"Bernard F","year":"2019","unstructured":"Bernard F, Troude L, Isnard S,  Long term surgical results of 154 petroclival meningiomas: a retrospective multicenter study. Neurochirurgie. 2019;65(2-3):55\u201362."},{"issue":"8","key":"b15","series-title":"Acta Neurochir (Wien)","first-page":"1367","article-title":"Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients","volume":"155","author":"Li D","year":"2013","unstructured":"Li D, Hao SY, Wang L,  Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir (Wien). 2013;155(8):1367\u20131383."},{"issue":"7","key":"b16","series-title":"Acta Neurochir (Wien)","first-page":"1099","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."},{"issue":"2","key":"b17","series-title":"Front Biosci (Elite Ed)","first-page":"587","article-title":"Surgical treatment of meningiomas","volume":"1","author":"Bambakidis NC","year":"2009","unstructured":"Bambakidis NC, Nakaji P. Surgical treatment of meningiomas. Front Biosci (Elite Ed). 2009;1(2):587\u2013599."},{"issue":"3","key":"b18","series-title":"Neurosurgery","first-page":"708","article-title":"Combined petrosal approach to petroclival meningiomas","volume":"51","author":"Cho CW","year":"2002","unstructured":"Cho CW, Al-Mefty O. Combined petrosal approach to petroclival meningiomas. Neurosurgery. 2002;51(3):708\u2013718."},{"issue":"6","key":"b19","series-title":"Acta Neurochir (Wien)","first-page":"1697","article-title":"Differences in surgical outcome between petroclival meningioma and anterior petrous meningioma","volume":"163","author":"Jung IH","year":"2021","unstructured":"Jung IH, Yoo J, Park HH, Hong CK. Differences in surgical outcome between petroclival meningioma and anterior petrous meningioma. Acta Neurochir (Wien). 2021;163(6):1697\u20131704."},{"issue":"1","key":"b20","series-title":"J Neurosurg","first-page":"65","article-title":"Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas","volume":"97","author":"Lee JY","year":"2002","unstructured":"Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg. 2002;97(1):65\u201372."},{"issue":"3","key":"b21","series-title":"Neurosurgery","first-page":"546","article-title":"Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients","volume":"56","author":"Little KM","year":"2005","unstructured":"Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery. 2005;56(3):546\u2013559."},{"issue":"6","key":"b22","series-title":"Neurosurgery","first-page":"965","article-title":"Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up","volume":"60","author":"Natarajan SK","year":"2007","unstructured":"Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery. 2007;60(6):965\u2013981."},{"issue":"4","key":"b23","series-title":"Stereotact Funct Neurosurg","first-page":"209","article-title":"Gamma Knife radiosurgery for petroclival meningioma: long-term outcome and failure pattern","volume":"95","author":"Kim JW","year":"2017","unstructured":"Kim JW, Kim DG, Se YB,  Gamma Knife radiosurgery for petroclival meningioma: long-term outcome and failure pattern. Stereotact Funct Neurosurg. 2017;95(4):209\u2013215."},{"issue":"3 Suppl Operative","key":"b24","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":"5","key":"b25","series-title":"J Neurosurg","first-page":"1278","article-title":"Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas","volume":"114","author":"Ohba S","year":"2011","unstructured":"Ohba S, Kobayashi M, Horiguchi T,  Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas. J Neurosurg. 2011;114(5):1278\u20131287."},{"issue":"7","key":"b26","series-title":"Acta Neurochir (Wien)","first-page":"759","article-title":"Skull base chordomas: efficacy of surgery followed by carbon ion radiotherapy","volume":"151","author":"Takahashi S","year":"2009","unstructured":"Takahashi S, Kawase T, Yoshida K, Hasegawa A, Mizoe JE. Skull base chordomas: efficacy of surgery followed by carbon ion radiotherapy. Acta Neurochir (Wien). 2009;151(7):759\u2013769."},{"issue":"1","key":"b27","series-title":"J Neurosurg","first-page":"20","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","author":"Couldwell WT","year":"1996","unstructured":"Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg. 1996;84(1):20\u201328."},{"issue":"4","key":"b28","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Pretemporal trans-Meckel\u2019s cave transtentorial approach for large petroclival meningiomas","volume":"44","author":"Liao CH","year":"2018","unstructured":"Liao CH, Wang JT, Lin CF,  Pretemporal trans-Meckel\u2019s cave transtentorial approach for large petroclival meningiomas. Neurosurg Focus. 2018;44(4):E10."},{"issue":"5","key":"b29","series-title":"J Neurosurg","first-page":"1268","article-title":"Petroclival meningiomas: study on outcomes, complications and recurrence rates","volume":"114","author":"Nanda A","year":"2011","unstructured":"Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg. 2011;114(5):1268\u20131277."},{"issue":"2","key":"b30","series-title":"Neurosurg Rev","first-page":"173","article-title":"Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension","volume":"34","author":"Samii M","year":"2010","unstructured":"Samii M, Gerganov V, Giordano M, Samii A. Two step approach for surgical removal of petroclival meningiomas with large supratentorial extension. Neurosurg Rev. 2010;34(2):173\u2013179."},{"issue":"5","key":"b31","series-title":"J Neurosurg","first-page":"1053","article-title":"ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article","volume":"111","author":"Adachi K","year":"2009","unstructured":"Adachi K, Kawase T, Yoshida K, Yazaki T, Onozuka S. ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article. J Neurosurg. 2009;111(5):1053\u20131061."},{"issue":"1","key":"b32","series-title":"Int J Cancer","first-page":"13","article-title":"Production of a mouse monoclonal antibody reactive with a human nuclear antigen associated with cell proliferation","volume":"31","author":"Gerdes J","year":"1983","unstructured":"Gerdes J, Schwab U, Lemke H, Stein H. Production of a mouse monoclonal antibody reactive with a human nuclear antigen associated with cell proliferation. Int J Cancer. 1983;31(1):13\u201320."},{"issue":"5","key":"b33","series-title":"Cancer","first-page":"1538","article-title":"Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma","volume":"94","author":"Ho DM","year":"2002","unstructured":"Ho DM, Hsu CY, Ting LT, Chiang H. Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma. Cancer. 2002;94(5):1538\u20131547."},{"issue":"5","key":"b34","series-title":"J Neurosurg","first-page":"804","article-title":"Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment","volume":"109","author":"Iwai Y","year":"2008","unstructured":"Iwai Y, Yamanaka K, Ikeda H. Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg. 2008;109(5):804\u2013810."},{"issue":"10","key":"b35","series-title":"Cureus","first-page":"e6001","article-title":"Staged Gamma Knife radiosurgery for large skull base meningiomas","volume":"11","author":"Iwai Y","year":"2019","unstructured":"Iwai Y, Yamanaka K, Shimohonji W, Ishibashi K. Staged Gamma Knife radiosurgery for large skull base meningiomas. Cureus. 2019;11(10):e6001."},{"issue":"2","key":"b36","series-title":"Hum Pathol","first-page":"140","article-title":"Prognostic significance of MIB-1, p53, and bcl-2 immunoreactivity in meningiomas","volume":"29","author":"Karamitopoulou E","year":"1998","unstructured":"Karamitopoulou E, Perentes E, Tolnay M, Probst A. Prognostic significance of MIB-1, p53, and bcl-2 immunoreactivity in meningiomas. Hum Pathol. 1998;29(2):140\u2013145."},{"issue":"5","key":"b37","series-title":"Pathol Res Pract","first-page":"305","article-title":"The significance of immunohistochemical expression of Ki-67, p53, p21, and p16 in meningiomas tissue arrays","volume":"204","author":"Terzi A","year":"2008","unstructured":"Terzi A, Saglam EA, Barak A, Soylemezoglu F. The significance of immunohistochemical expression of Ki-67, p53, p21, and p16 in meningiomas tissue arrays. Pathol Res Pract. 2008;204(5):305\u2013314."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/1\/article-p108.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/1\/article-p108.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/1\/article-p108.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T11:47:24Z","timestamp":1732621644000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/1\/article-p108.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":37,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2023.11.jns231532","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}