Abstract
A dilemma presents itself to the otoneurologist and neurosurgeon when determining
the least invasive surgical approach to giant cholesterol cysts (GCC) of the petrous
apex of the temporal bone. These lesions can be diagnosed with a fair degree of certainty
with imaging studies. Transmastoid and subcochlear approaches may be inadequate to
access these lesions, and the transcochlear approach results in the sacrifice of hearing.
A minimally invasive, combined microscopic and endoscopic sublabial transsphenoid
approach to drain and marsupalize these lesions has been chosen by the authors in
those cases that are anatomically possible. The purpose of this article is to establish
the feasibility of exenterating anterior petrous apex cells by way of this approach,
and to better conceptualize the anatomy of the Spheno-Petro-Clival Complex (SPC).
Ten Fresh cadaveric whole head specimens were dissected with, endoscopic/microscopic
control, through midline, sublabial, transseptal, and transsphenoidal routes to the
petrous apex. The three-dimensional relationships of the sphenoid sinus, petrous apex,
and the clivus were further demonstrated by dissections of the same specimens from
the posterior fossa. Sagittal cut sections were also performed. After confirming the
feasibility of this approach by dissections, the technique was adopted for performing
drainage of GCC of the petrous apex in clinical cases.
