| Although development of the modem skull base surgery has made it possible to get high radical resection rate of the skull base lesions. The radical resection rate of the tumors on the petroclival region is still lower. They have a characteristic of invading to the superior clivus and the middle fossa ,so the total resection was more difficult to be gotten . For the type of the petroclival lesions invading the middle fossa and the superior clivus, there hasn't a satisfactory approach to get a total resection of it. It is imperative to find an approach with good exposure and less complication to deal with it. This study was to determine the safety, feasibility, practicality and effectiveness of the expanding retrosigmoid suprameatal (ERSSMA)approach dealing with the tumor invading the middle and superior clivus by the study of it's microsurgical anatomy.The advantage of less damage which the retrosigmoid approach had was reserved in the retrosigmoid suprameatal approach (RSSMA) . The shortcoming of the insufficiency exposure was overcome because the view line was hindered by the suprameatal terbucle . There hadn't areport about the study on the microsurgical anatomy of this approach in our country and there were rarely found in the data overseas.The development of the neuro-otology has made it possible for the resection of the semicircular with the preservation of hearing .By the use of this skill ,the removal range of the petrosal bone could be enlarged. This is called the expanding retrosigmoid approach. (ERSSMA). There hasn't an article describing it nowadays in the world. This is the first study on the microsurgical anatomy of the ERSSMA..The part 1 of this study stressed on the craniotomy device of the retrosigmoid aproach to improve the operating skills. Part 2 aimed at the safety and feasibility of the ERSSMA .Part 3 deal with the microanatomy of the RSSMA and it's effectiveness of it's exposure to the middle fossa and the superior clivus. Part 4 makes the efforts on the study of the effectiveness and the practicability of the ERSSMA by the use of the skills of semicircular resection of the modern otology.Part IThe study on the Surgical Anatomy of the Retrosigmoid and the Improvement of the Craniotomy SkillsObjective To improve the craniotomy skills of the retrosigmoid approach and to find a safer, fast, more effective and less postoperative complication method. Materials: 10 human cranium, 15 formalin fixedcadavers and 3 fresh cadavers, high speed drills. Sony S-75 cyber shot. Lecia M500-N and Opton operation microscopes. Methods: The anatomic relationship between the cross point(A) of the sigmoid and the transverse sinus and the asterion(S), the cross point of the perpendicular and the horizontal(B) and point of the fissure of the occipital-mastoid at the fundus of the mastoid (C) were determined .Then the length of A-S and B-C were measured .Results: (1) The A point was lateral and inferior to the asterion, 10.8 + 1.1 mm on horizontal plane, 3.5 + 0.7mm on the longitude plane. There were no statistic difference between the data of the cranium and the cadavers. (2) The B point located lateral and inferior to the point C. 5.8 + 1.8mm on the horizontal plane, 8.4 + 0.8mm on the longitude plane. There were no statistic difference between the data of the cranium and the cadavers. Conclusion: In the craniotomy of the retrosigmoid approach, the lateral two hole should devised lateral and inferior to the asterion and fissure of the occipital-mastoid at the fundus of mastoid. It is a safe and fast drilling method .Part IIThe study on the safety and the feasibility of the expanding retrosigmoid suprameatal approachObjective To certified the safety and the feasibility of the ERSSMA by the study of it's radiology and microanatomy .Materials were the same as them of Part 1. Methods: Each specimen was scanned by CT inthree dimensions with the one millimeter slice. The modified retrosigmoid approach was performed. The device of the bone flap was accor...
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