2026 Proffered Presentations
S230: APPROACH RELATED COMPLICATIONS OF THE COMBINED TRANSPETROSAL APPROACH: EXPERIENCE OF A SINGLE CENTER
Tingting Jiang; Nobuyuki Watanabe; Jerold Justo; Tancredo Alcântara; Paolo Di Russo; Matei Militaru; Arianna Fava; Thibault Passeri; Sébastien Froelich; Lariboisiére Hospital, Paris, France
Background: The combined transpetrosal approach (CTA) represents one of the most complex skull base approaches, carrying potential significant risk of complications. This study presents a large single-center cohort of patients treated with CTA, focusing on approach-related complications and their correlation with some radiological and clinical factors.
Methods: We retrospectively reviewed all CTA procedures performed at our institution between 2013 and 2025. Medical records, operative videos, radiological images and follow-up data were analyzed.
Results: We describe in detail our surgical technique, its progressive refinement to simplify the approach, and the technical nuances adopted to minimize complications. Eighty-two patients were included, with a male-to-female ratio of 1:2. Surgeries were performed on the left side in 52% of cases and on the right side in 48%. The mean age at surgery was 50 years. Treated pathologies included large petroclival meningiomas (82%), epidermoid cysts (10%), schwannomas (4%), and chordomas or chondrosarcomas (4%). The mean lesion volume was 34 cm3. Gross-total or near-total resection was achieved in 63% of cases, subtotal resection in 18%, and partial resection in 17%. Seventy-one patients underwent a single-stage CTA, while 11 required a two-stage procedure. Regarding the approach-related complications, the most common was venous sinus thrombosis (33%), all patients were asymptomatic and half of them received anticoagulant treatment. Seizures occurred in 14 patients (17%): 3 were intraoperative and 11 postoperative. Among the latter, 2 were generalized seizures and 9 were partial. All patients were managed with antiepileptic drugs. Hearing impairment due to otitis media was observed in 24% of patients; however, none of the patients experienced disability in activities of daily living related to this. Pseudomeningocele developed in 5 patients (6%), all of which resolved with lumbar punctures or drainage. CSF leak occurred in 3 patients (3%). FLAIR hyperintensity on postoperative MRI was observed in 31 patients (37%): the hyperintensity volume was < 1 cm³ in 9 patients, between 1 and 2 cm³ in 11 patients, and > 2 cm³ in the remaining 11 patients. Less frequent complications included scar infection (2%), meningitis (4%), abdominal hematoma at the fat graft harvest site (7%), and temporomandibular joint dysfunction (2%). According to the Clavien-Dindo classification of surgical complications, 29% were Grade I (no specific treatment required), 30% were Grade II (requiring medical treatment such as antiepileptics or anticoagulants), 11% required surgical management (1 case of CSF leak, 1 extra-dural collection, 3 abdominal hematomas, 2 scar infections), and only one case of severe meningitis was classified as Grade IV, requiring ICU admission.
Conclusions: A thorough understanding of the potential complications associated with CTA is essential when considering this approach. Our experience demostrates that approach-related complications are generally minor and acceptable in most cases. Some of these complications have been reduced over time due to the evolution of our surgical technique, which has become less invasive and more targeted, exposing only what is necessary to remove the lesion. Preoperative imaging analysis plays a key role in identifying risk factors and minimizing approach-related complications.