Objective The aims of the study are (1) to evaluate the extended middle fossa approach (eMCF) for resection of tumors in the petroclivus and anterior cerebellopontine angle (CPA) and (2) to compare surgical outcomes between elderly (≥65 years) and nonelderly patients.

Design Retrospective cohort.

Setting Tertiary referral center.

Participants Adults with petroclival, anterior CPA, or posterior fossa lesions who underwent an eMCF approach from 2012 to 2021 were included in the study.

Main Outcome Measure Demographics, symptoms, cranial nerve (CN) function, and postoperative outcomes.

Results Twenty-nine patients (mean age of 55 years, 59% females) were identified. Eleven (38%) were ≥65 years (65–79 years). The most common pathology was meningioma (n = 13, 45%), followed by vestibular schwannoma (n = 4, 14%) and squamous cell carcinoma (n = 3, 10%). Nineteen tumors (65.5%) were located in the petroclivus, 7 (24%) involved the cavernous sinus, and 10 (34%) were located in the posterior fossa. The mean tumor maximal diameter was 3.4 cm (range: 1.3–7.9 cm). Gross total tumor resection was accomplished in 15 (52%) patients. Most patients (n = 23, 79%) did not develop new CN deficits postoperatively. Of the 13 patients who had complete pre- and postoperative audiometric data, 69% (n = 9) maintained their hearing. Comparing the elderly versus nonelderly patients, there were no significant differences in the development of new CN palsies (p = 0.14), length of stay (p = 0.91), or incidence of postoperative complications (p = 0.30).

Conclusions The eMCF approach provides exposure to the petroclival region, anterior CPA cistern, and posterior fossa for a variety of pathologies. It has a favorable safety profile in the elderly (≥65 years) population with low morbidity.

目的 本 研究的目的是 (1) 评估扩大中颅窝入路 (eMCF) 切除岩斜肌和桥小脑前角 (CPA) 肿瘤的效果；(2) 比较老年人（≥ 65 岁）和非老年患者。

设计 回顾性队列。

设置 三级转诊中心。

参与者 2012 年至 2021 年间接受 eMCF 入路治疗的患有岩斜、前 CPA 或后颅窝病变的成人被纳入研究。

主要结果指标 人口统计、症状、颅神经 (CN) 功能和术后结果。

结果 确定了 29 名患者（平均年龄 55 岁，59% 为女性）。11 名 (38%) 年龄≥65 岁（65-79 岁）。最常见的病理是脑膜瘤 ( n  = 13, 45%)，其次是前庭神经鞘瘤 ( n  = 4, 14%) 和鳞状细胞癌 ( n  = 3, 10%)。19 例（65.5%）肿瘤位于岩斜肌，7 例（24%）肿瘤累及海绵窦，10 例（34%）位于后颅窝。平均肿瘤最大直径为 3.4 cm（范围：1.3–7.9 cm）。15 名 (52%) 患者完成了肿瘤总切除。大多数患者（n  = 23，79%）术后没有出现新的 CN 缺陷。在 13 名拥有完整术前和术后听力测定数据的患者中，69% ( n  = 9) 保持了听力。比较老年患者与非老年患者，新发 CN 麻痹的发生率 ( p  = 0.14)、住院时间 ( p  = 0.91) 或术后并发症的发生率 ( p = 0.30)没有显着差异 。

结论 eMCF 入路可暴露岩斜区、前 CPA 池和后颅窝，以治疗多种病变。它在老年人（≥65 岁）人群中具有良好的安全性，且发病率低。