Petroclival junction [Neurosurgery Wiki]

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=====Petroclival junction=====
{{ ::petroclivaljunction.jpg|}}

The petroclival junction (PCJ) is a challenging [[skull base]] location from neurosurgical point of view, especially if the retrocarotid space has to be reached.

A combined [[petrosal approach]] is a suitable technique for the resection of medium-to-large [[petroclival meningioma]]s (PCMs), and suited for patients with serviceable hearing on the side of the lesion.

This approach enhances petroclival exposure and the degree of tumor resection, especially in the area of the [[petroclival junction]], middle clivus, apical [[petrous bone]], posterior [[cavernous sinus]], and [[Meckel's cave]]. The combined petrosal approach also allows better visualization of the contralateral side and the ventral [[brainstem]], which facilitates safe dissection of the tumor from the brainstem, the basilar artery, and the perforators. If a patient has an early draining bridging vein to the tentorial sinus (before it reaches the transverse-sigmoid junction) or a prominent [[sigmoid sinus]] and [[jugular bulb]], the combined petrosal approach provides significant working space
((Cho CW, Al-Mefty O. Combined petrosal approach to petroclival meningiomas.
Neurosurgery. 2002 Sep;51(3):708-16; discussion 716-8. PubMed PMID: 12188949.)).

Simal-Julián et al. present the technique step by step, introducing a critical concept about the optimization of the petroclival drilling, generating the [[carotid clival window]] (CCW). The CCW is delimited by the paraclival segment of the [[internal carotid artery]] ICA anterolaterally, the [[petrous bone]] posterolaterally, the clival dura medially, the synchondrosis inferiorly, and the cavernous sinus superiorly; therefore, this approach exposes an important nuance to augment the previous approaches for PCJ and retrocarotid space.

This technique provides a good surgical window and carries minimal risk
((Simal-Julián JA, Miranda-Lloret P, Botella-Asunción C, Kassam A. Full
endoscopic endonasal expanded approach to the petroclival region: optimizing the 
carotid-clival window. Acta Neurochir (Wien). 2014 Aug;156(8):1627-9. doi:
10.1007/s00701-014-2125-6. Epub 2014 May 23. Erratum in: Acta Neurochir (Wien).
2014 Oct;156(10):1927. Kassam, Armin [corrected to Kassam, Amin]. PubMed PMID:
24855022.
)).