Inframeatal intradural retrosigmoid petrosectomy (IIRP): Multicenter experience and anatomical review of an effective approach to the petroclival region.

INTRODUCTION

Tumorous and infectious lesions of the petrous bone pose a surgical challenge due to their deep location and proximity to critical neurovascular structures. Inframeatal intradural retrosigmoid petrosectomy (IIRP) is an alternative route that allows direct access to the petrous apex with minimal morbidity.

METHODS

Retrospective study of 11 patients who underwent IIRP between 2015 and 2025 in two hospitals in southern Galicia. Demographic variables, type of lesion, surgical time, degree of resection, complications, and progression-free survival were collected. A descriptive analysis and Kaplan-Meier curve were performed.

RESULTS

Eleven patients were included (7 women, 4 men; mean age 48.9 years). Lesions included invasive cholesteatoma (n=4), petroclival meningiomas (n=2), chondrosarcoma (n=1), atypical schwannoma (n=1), squamous cell carcinoma (n=1), breast cancer metastasis (n=1) and an intraosseous abscess due to Actinomyces (n=1). Gross total resection was achieved in 81.8%, with one transient complication (9.1%) and one recurrence. Progression-free survival analysis showed satisfactory recurrence-free survival up to 20 months.

CONCLUSION

IIRP is a safe, effective, and versatile technique for approaching select lesions of the petrous bone. It allows sufficient exposure with low morbidity and is also useful in refractory infectious cases.