Intradural Combined Transpetrosal Approach for Primary Pontine Hemorrhage

Shinya Ichimura, Kento Takahara, Yoichi Mochizuki, Koji Fujii

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Objective: The standard combined transpetrosal approach (CTPA) is fundamentally an epidural approach that has been quite successfully practiced for many decades. However, it has some disadvantages, such as cosmetic problems, difficulties with custom-tailored petrosectomy, and cerebrospinal fluid leakage, as it is a complicated epidural procedure. We describe here a case of primary pontine hemorrhage via intradural CTPA (iCTPA), which is a modified technique of CTPA and includes intradural anterior petrosectomy and partial posterior petrosectomy without mastoidectomy and skeletonization of the sigmoid sinus. Methods: A 63-year-old woman with primary pontine hemorrhage underwent surgery via iCTPA to improve postoperative functional outcomes. After the temporal craniotomy without mastoidectomy and skeletonization of the sigmoid sinus, Kawase's triangle and Trautmann's triangle were identified from the intradural space. Resection of Kawase's triangle and partial resection of Trautmann's triangle were performed to approach the frontotemporal surface of the pons. The hematoma was irrigated and totally removed after corticotomy on the pons. Results: The postoperative symptoms of the patient improved within 2 weeks without surgical complication. Conclusions: The intradural approach allows for custom-tailored petrosectomy and is more straightforward than the epidural route, although it can injure the vein of Labbé. Moreover, it can also reduce cosmetic problems and cerebrospinal fluid leakage. iCTPA could provide enough working space for the frontolateral surface of pontine and petroclival lesions without the need for mastoidectomy and skeletonization of the sigmoid sinus.

Original languageEnglish
Pages (from-to)194-198
Number of pages5
JournalWorld neurosurgery
Publication statusPublished - 2019 Jul
Externally publishedYes


  • Combined transpetrosal approach
  • Intradural approach
  • Primary pontine hemorrhage
  • Subtemporal approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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