Hearing preservation with the transcrusal approach to the petroclival region

Objective: We studied the hearing results and outcomes after transcrusal craniotomy. Study Design: We conducted a retrospective review. Setting: This study was conducted at a tertiary care hospital. Patients: We studied 10 consecutive patients, including two men and eight women, who underwent transcrusal craniotomy for petroclival masses or tumors. Intervention: The intervention consisted of therapeutic removal of petroclival meningioma. Main Outcome Measure: The main outcome measure of this study was hearing preservation as measured by standard audiogram. Results: There were six meningiomas, one eighth nerve schwannoma, one fifth nerve schwannoma, one chordoma, and one midbasilar artery aneurysm. Postoperative hearing was measured according to the AAOHNS criteria. Complications and further therapies were recorded. Postoperative hearing was measured in eight. The cochlear nerve was severed in one patient. One was unavailable for follow up. Eight patients retained hearing at or near preoperative levels, seven with SRT within 10 dB and speech discrimination within 10% of preoperative levels. Four patients presented with trigeminal symptoms, one with third nerve palsy and two with facial weakness. Postoperative deficits included fourth, sixth, seventh, and eighth nerve palsies in three patients. Complications included one wound infection, two cerebrospinal fluid leak, and two cases of meningitis, both of which were sterile. There were secondary procedures in five patients-three radiosurgery, two shunts, one tracheotomy, and one g-tube. Conclusions: Transcrusal craniotomy is a safe and effective approach to the petroclival region. Excellent hearing results can be expected with this technique.