{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:07:24Z","timestamp":1783210044505,"version":"3.54.6"},"reference-count":30,"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 extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labb\u00e9 is first identified and protected. Cerebrospinal fluid ([CSF] 50\u2013100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal.<\/jats:p>\n<jats:p>The modified transdural anterior petrosectomy exposure has been used in nine patients\u2014two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns.2006.104.1.38","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:28:14Z","timestamp":1201177694000},"page":"38-46","source":"Crossref","is-referenced-by-count":43,"title":["Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions"],"prefix":"10.3171","volume":"104","author":[{"given":"Hans-Jakob","family":"Steiger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Heinrich-Heine-University Medical School, D\u00fcsseldorf; and Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"H\u00e4nggi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Heinrich-Heine-University Medical School, D\u00fcsseldorf; and Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Stummer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Heinrich-Heine-University Medical School, D\u00fcsseldorf; and Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Heinrich-Heine-University Medical School, D\u00fcsseldorf; and Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1040038","series-title":"HNO","first-page":"381","article-title":"Chirurgisch-anatomische Orientierungshilfen fur den erweiterten transtemporalen Zugang zum Kleinhirnbruckenwinkel","volume":"35","year":"1987"},{"key":"b2-1040038","series-title":"Neurosurgery","first-page":"1225","article-title":"The Kawase approach to retrosellar and upper clival basilar aneurysms","volume":"44","year":"1999"},{"key":"b3-1040038","series-title":"Neurosurgery","first-page":"1009","article-title":"Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct","volume":"34","year":"1994"},{"key":"b4-1040038","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"709","DOI":"10.3171\/jns.1992.77.5.0709","article-title":"The subtemporal, transcavernous, anterior transpetrosal approach to the upper brain stem and clivus","volume":"77","year":"1992"},{"key":"b5-1040038","series-title":"Arch Otolaryngol","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1001\/archotol.1966.00760030269004","article-title":"A combined approach to the cerebellopontine angle. 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