Usefulness of Posterior Transpetrosal Approach for Paramedian Vascular Lesions

The presigmoid posterior transpetrosal approach can allow better multidirectional access to skull base lesions. A wide surgical field extending above and below the tentorium is created through the tentorial incision. To date, this method has been useful in 4 cases of paramedian vascular lesions (2 cases of aneurysm, 1 case of cerebellar arteriovenous malformation, and 1 case of cerebellar hemangioblastoma) at our hospital. The feeder and proximal artery in the deep part of the lesion, and the drainer and distal artery in the superficial part, can be viewed directly in a wide surgical field. By determining the bone removal range for each individual case, drilling-related complications can be reduced and the operation time can be shortened.