{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T22:52:54Z","timestamp":1782600774368,"version":"3.54.5"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2006,1]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The authors quantitatively assessed the working areas and angles of attack associated with retrosigmoid (RS), combined petrosal (CP), and transcochlear (TC) craniotomies.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Four silicone-injected cadaveric heads were bilaterally dissected using three approaches progressing from the least to the most extensive. Working areas were determined using the Optotrak 3020 system on the upper and middle thirds of the petroclivus and brainstem. Angles of attack were studied using the Elekta SurgiScope at the Dorello canal and the origin of the anterior inferior cerebellar artery (AICA).<\/jats:p>\n<jats:p>The TC approach provided significantly greater (p &lt; 0.001) working areas at the petroclivus (755.6 \u00b1 130.1 mm<jats:sup>2<\/jats:sup>) and brainstem (399.3 \u00b1 68.2 mm<jats:sup>2<\/jats:sup>) than the CP (354.1 \u00b1 60.3 and 289.7 \u00b1 69.9 mm<jats:sup>2<\/jats:sup>) and RS approaches (292.4 \u00b1 59.9, 177.2 \u00b1 54.2 mm<jats:sup>2<\/jats:sup>, respectively). The brainstem working area associated with the CP approach was significantly larger (p &lt; 0.001) than that associated with the RS route. There was no difference in the petroclival working area comparing the CP and RS approaches (p = 0.149). The horizontal and vertical angles of attack achieved using the TC approach were wider than those of the CP and RS at the Dorello canal and the origin of the AICA (p &lt; 0.001).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The CP approach offers a more extensive working area than the RS for lesions involving the anterolateral surface of the brainstem, but not for petroclival lesions. The TC approach provides the widest corridor, improving the working area and angle of attack to both areas, but hearing must be sacrificed and the facial nerve is at risk.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns.2006.104.1.137","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:28:14Z","timestamp":1201177694000},"page":"137-142","source":"Crossref","is-referenced-by-count":95,"title":["Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region"],"prefix":"10.3171","volume":"104","author":[{"given":"Rungsak","family":"Siwanuwatn","sequence":"first","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushpa","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberval Gadelha","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Spetzler","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Preul","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1040137","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","year":"2000"},{"key":"b2-1040137","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","year":"1988"},{"key":"b3-1040137","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","year":"1994"},{"key":"b4-1040137","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/BF01417683","article-title":"The far lateral-combined supra-and infratentorial approach: clinical experience","volume":"134","year":"1995"},{"key":"b5-1040137","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3171\/jns.1948.5.2.0131","article-title":"Posterior fossa meningiomas","volume":"5","year":"1948"},{"key":"b6-1040137","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/00006123-200207000-00022","article-title":"Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study","volume":"51","year":"2002"},{"key":"b7-1040137","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","year":"2002"},{"key":"b8-1040137","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3171\/jns.1996.84.1.0020","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","year":"1996"},{"key":"b9-1040137","series-title":"Neurosurgery","first-page":"550","article-title":"Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach","volume":"50","year":"2002"},{"key":"b10-1040137","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/0090-3019(88)90095-X","article-title":"A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas","volume":"30","year":"1988"},{"key":"b11-1040137","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","year":"2000"},{"key":"b12-1040137","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","year":"2001"},{"key":"b13-1040137","series-title":"Otolaryngology","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1177\/019459987808600522","article-title":"Surgery of the skull base: transcochlear approach to the petrous apex and clivus","volume":"86","year":"1978"},{"key":"b14-1040137","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","year":"1991"},{"key":"b15-1040137","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/00006123-199807000-00054","article-title":"The anterior subtemporal, medial transpetrosal approach to the upper basilar artery and ponto-mesencephalic junction","volume":"43","year":"1998"},{"key":"b16-1040137","series-title":"Otolaryngol Clin North Am","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1016\/S0030-6665(05)70375-3","article-title":"Petroclival tumors: a synthesis","volume":"34","year":"2001"},{"key":"b17-1040137","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1227\/00006123-198901000-00003","article-title":"Surgery of petroclival meningiomas: report of 24 cases","volume":"24","year":"1989"},{"key":"b18-1040137","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0967-5868(99)90598-2","article-title":"Resection of large petroclival meningiomas by the simple retrosigmoid route","volume":"6","year":"1999"},{"key":"b19-1040137","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"824","DOI":"10.3171\/jns.2000.92.5.0824","article-title":"Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus","volume":"92","year":"2000"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/104\/1\/article-p137.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/104\/1\/article-p137.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/104\/1\/article-p137.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T18:17:23Z","timestamp":1679854643000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/104\/1\/article-p137.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1]]},"references-count":19,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/jns.2006.104.1.137","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2006,1]]}}}