Posterior petrosal transotic approach for cerebellopontine angle hemangioblastoma: Technical case report

Michael A. Mooney, Claudio Cavallo, Evgenii Belykh, Sirin Gandhi, Justin Mascitelli, Mark C. Preul, Shawn Stevens, Kaith K. Almefty, Michael T. Lawton

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND IMPORTANCE: Although posterior petrosal approaches are utilized less frequently in many practices today, they continue to provide distinct surgical advantages in carefully selected cases. Here, we report a case of a recurrent cerebellopontine angle (CPA) hemangioblastoma that had failed a prior, more conservative, surgical approach. We provide cadaveric dissections of variations of posterior petrosal approaches to illustrate the advantages of the selected approach. CLINICAL PRESENTATION: A 70-yr-old female presented with a growing left CPA hemangioblastoma. The lesion had undergone a prior subtotal resection from a retrosigmoid approach and subsequent adjuvant radiation treatment. The patient had worsening left facial strength, progressive balance difficulty, and absent left auditory function. Preoperative angiogram demonstrated arterial blood supply from the left anterior inferior cerebellar artery (AICA) that was deemed unsafe for embolization due to significant arteriovenous shunting. A posterior petrosal transotic approach was performed in order to optimize the working angle to the anterior brainstem and afford the ability to occlude the vascular supply from AICA prior to surgical resection of the lesion. CONCLUSION: The posterior petrosal transotic approach offers an improved surgical working angle to the anterior brainstem compared to the translabyrinthine approach. This advantage can be particularly important with vascular tumors that receive blood supply anteriorly, as in this case from AICA, and can improve the safety of the resection.

Original languageEnglish (US)
Pages (from-to)E269-E273
JournalOperative Neurosurgery
Volume17
Issue number6
DOIs
StatePublished - 2019

Keywords

  • Cerebellopontine angle tumor
  • Hemangioblastoma
  • Posterior petrosectomy
  • Transotic approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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