Li Kevin L, Agarwal Vijay, Moskowitz Howard S, Abuzeid Waleed M
Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA.
World J Otorhinolaryngol Head Neck Surg. 2020 Jun 3;6(2):106-114. doi: 10.1016/j.wjorl.2019.11.002. eCollection 2020 Jun.
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.
岩尖因其位于颅底深处且周围有许多重要结构，是一个难以到达的手术区域。岩尖病变范围从硬膜外胆固醇肉芽肿、胆脂瘤、不对称气化、骨髓炎到硬膜内脑膜瘤和神经鞘瘤。某些病变，如胆固醇肉芽肿，可通过引流处理，而肿瘤性病变则必须完全切除。手术选择包括开放手术、内镜手术和联合技术，可分为前入路、侧入路和后入路。入路的选择取决于病变的性质、相对于重要结构的位置以及向周围结构的延伸情况，这需要在术前进行全面评估，并与患者讨论手术目标。本前沿综述的目的是讨论岩尖最常用的手术入路以及这些入路所基于的解剖结构。
