Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.
Keywords: Cerebellopontine angle; Combined petrosal approach; Modified lateral supraorbital approach; Petroclival meningioma; Trigeminal schwannoma.