Individual-Designed Approaches and Microsurgery for Huge Petrous Bone-Invasive Tumors: Report of 57 Cases

Background A lot of important structures located in or beside the petrous bone. When the lesions invaded the petrous bone, the gross total resection of them would be difficult and a challenge to neurosurgeon, especially if the lesions are huge.

Objective For achieving the gross total resection of the huge petrous bone-invasive tumors and minimal damage to the important structures in the petrous bone, we combined several different approaches to every individual patient. We also aimed to describe the technical nuances and tips of the individual-designed approaches and microsurgery.

Methods Fifty-seven patients, who have huge petrous bone-invasive tumors (average diameter is ∼5 cm), were admitted to our department between 2014 and 2016. All of them underwent individualized microsurgery for resection of the lesions. According to the relationship between the tumor and petrous bone, several different approaches were combined or improved. We designed different approach and microsurgery for every individual patient.

Result The gross total resection was achieved in 52 cases, subtotal resection in 3 cases, and partial resection in 2 cases. Fifty patients did not have new neurological dysfunction. In the other seven patients who had new neurological dysfunction, four patients got better after 3 to 6 months. The preoperative neurological dysfunction in 29 patients was improved after the surgery. The most common complication was leakage of CSF. five patients had this complication. There were no deaths in this study.

Conclusion The individual-designed approaches and microsurgery can increase the gross total resection rate of the tumors and nerve protection rate. As a result, the outcome of the patients who have the huge petrous bone-invasive tumors was improved significantly.