Clinical application of scalp markers and three-dimensional sliced computer tomography reconstructions of the skull transverse-sigmoid sinus groove in the retrosigmoid approach

Wang, Chao; Han, Guoqiang; You, Chao; Liu, Chuangxi

doi:10.5137/1019-5149.jtn.19342-16.0

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Te asterion is defned as the intersection of the occipitomastoid, parietomastoid, and lambdoid sutures [15]. While it has been widely considered to overlie the superior curvature of the sigmoid sinus, more recent studies have noted signifcant anatomical variations in this positional relationship [2,[9][10][11]. Te spatial relationship between the asterion and the superior curvature of the sigmoid sinus is not constant from one individual to another and cannot be relied on to locate the keyhole for a retrosigmoid craniotomy accurately.…”

Section: Discussionmentioning

confidence: 99%

“…However, Bozbuga et al [7] and da Silva et al [8] present key studies (anatomical, radiological, and clinical) reporting that the asterion is not a reliable landmark for burr hole placement in the retrosigmoid approach. Indeed, an increasing number of studies have demonstrated that there is considerable anatomic variation in the relationship between the asterion and the transverse-sigmoid junction, and incorrect venous sinus localization may result in sinus injury or insufcient surgical exposure [2,[9][10][11]. While other skull-surface landmarks are also used to locate the transverse-sigmoid junction, they have anatomic variations, and some are too far from the surgical incision to be practical for surgical use [12].…”

Section: Introductionmentioning

confidence: 99%

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Computed Tomography Study of the Retrosigmoid Craniotomy Keyhole Approach Using Surface Landmarks

Zhou

Liu

et al. 2023

International Journal of Clinical Practice

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Background. Due to a lack of accessibility and individual differences in surgical procedures, many previous studies on keyholes are not practical. Objective. To study the surface landmarks for optimal keyhole placement in the retrosigmoid approach. Methods. The three-dimensional (3D) skull images of 79 patients were reconstructed using workstations, with a total of 149 hemiskull base 3D images then analyzed. Skull-surface landmarks were marked, the lateral-skull surface was observed, and the positional relationships between the asterion and the extension line of the posterior margin of the mastoid process were measured. The position of the superior curvature of the sigmoid sinus groove was located before it was projected onto the lateral surface of the skull and defined as the keypoint. The positional relationship between the keypoint and the skull-surface landmarks was observed in an established coordinate system using spatial proportion relationships. Results. The asterion was located around the extension line of the posterior margin of the mastoid process, and the vertical distance from the extension line was <15 mm. It was found that 93.29% (139/149) of the keypoints were located in a 7 mm radius circle, with the center at (−0.41, −3.01) in the coordinate system in the 3D computed tomography images. Conclusion. When using this method, the spatial proportion relationship of the anatomical marks can accurately locate keyholes, therefore providing technical support when employing the retrosigmoid approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computed Tomography Study of the Retrosigmoid Craniotomy Keyhole Approach Using Surface Landmarks

Zhou

Liu

et al. 2023

International Journal of Clinical Practice

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“…Anatomical structures asterion, inion, superior nuchal line and suprameatal triangle were used as landmarks to locate the junction between transverse and sigmoid sinuses (15,16). However, further studies revealed that there were inconsistencies with the transverse and sigmoid junction and the location of these anatomical structures (15,17). Also, asterion was difficult to locate intra-operatively (19).…”

Section: Discussionmentioning

confidence: 99%

“…Asterion, inion, superior nuchal line and suprameatal triangle were such structures believed to be helpful in locating the transverse sigmoid sinus junction (15,16). However, during recent years cadaveric research on the location of these was found to be inconstant among individuals (15,17).…”

Section: Introductionmentioning

confidence: 99%

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

et al. 2018

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Introduction Hematoma due to dural-sinus damage is a known complication when introducing burr holes in open transcranial surgery. Our objective was to identify safe areas to avoid dural-sinus damage based on anatomical landmarks in translabyrinthine and retrosigmoid open surgical approaches where neuronavigation facilities are not available. Methods A descriptive anatomical study was conducted on adult skulls. Distances to transverse and sigmoid sinuses on either side were measured using fixed anatomical landmarks: asterion, inion, margins of suprameatal triangle and superior nuchal line. Measurements were standardized according to the cranial indices (cranial index=anteroposterior diameter/transverse diameter) of each skull. Results Thirty-two adult skulls (male:female=22:10) were studied. Mean cranial index, width of transverse and sigmoid sinuses were 0.785±0.045, 9.1±2.3mm and 9.7±1.2mm respectively. Mean vertical distances from asterion and inion to the transverse sinus were 1.1±3.4mm and 14.7±5.9mm respectively. Posterior border of the sigmoid sinus was located 14.7±5.9mm, and 59.9±7.4mm anterior to asterion and inion respectively. t-tests did not show significant differences of these distances on either sides (p>.05). Pearson's correlations were insignificant between the measurements and the cranial indices (p>.05). Measurements from the suprameatal triangle to the dural-sinuses had the minimum variance. In >95% of the times the sigmoid sinus was located ≤23 mm posterior and ≤7 mm superior to the suprameatal triangle. Discussion and conclusions Suprameatal triangle was a consistent surface landmark to locate dural-sinuses. Dural-sinus damage could be avoided in 95% of the times by placing burr hole at least 7mm superior and 23 mm posterior to the suprameatal triangle.

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“…Teranishi (2014) 18 88 pacientes 6.5 mm inferior, 6.5 mm lateral al asterion. Wang et al (2018) 21 108 pacientes Localización individualizada utilizando TC 3D y marcadores en cuero cabelludo. Zhou et al (2019) 22 16 hemisferios y 20 pacientes Localización de punto prequirúrgico basado en cálculos preoperatorios y referencias anatómicas.…”

Section: Pacientesunclassified

Localización preoperatoria de la trepanación inicial en el abordaje retrosigmoideo. Revisión de literatura y aplicación quirúrgica

Basili

Dorman

Angerami

et al. 2020

Rev. Argent. Neuroc.

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Objetivo: Evaluar una técnica eficaz y reproducible que permita determinar el sitio de la trepanación inicial en el abordaje retrosigmoideo.Materiales y métodos: Se empleó una muestra de 22 pacientes a fin de analizar la relación de la transición transverso – sigmoidea (TTS) con el asterion y la ranura digástrica. Todos los casos contaban con TC de cortes finos (1 mm de espesor). Se subdividieron los pacientes en dos grupos. Grupo 1: pacientes con patologías variables, sin alteraciones estructurales en la fosa posterior. Grupo 2: pacientes en los que se realizó un abordaje retrosigmoideo con planificación prequirúrgica del sitio de trepanación inicial.Discusión: Las referencias óseas (asterion y punto digástrico) pudieron identificarse en la totalidad de las TC 3D analizadas. Se analizaron las distancias empleando un sistema de coordenadas. La TTS se registró en el 78% de los casos anterior e inferior al asterion. En ningún caso se encontró la TTS superior al asterion, la ubicación en sentido inferior varió entre 0 mm y 25,5 mm (media 12,5 mm). En el plano anteroposterior, se registró una distancia entre -6,41 mm y 14,5 mm (media 4,09 mm), demostrando una gran variabilidad individual, comparable con lo descripto en la literatura. En el grupo 2, pudo predecirse de manera precisa la localización de la TTS, exponiendo la misma con la trepanación inicial.Conclusión: Se describe un método sencillo, eficaz, de libre acceso, que permite la ubicación del keyhole en el abordaje retrosigmoideo.

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Clinical application of scalp markers and three-dimensional sliced computer tomography reconstructions of the skull transverse-sigmoid sinus groove in the retrosigmoid approach

Abstract: The 3D sliced CT reconstruction of the skull transverse sinus and sigmoid sinus groove was helpful in the approach of retrosigmoid craniotomy for sinus exposure, sinus protection, and the prevention of cerebrospinal fluid leakage and pseudomeningocele.

Cited by 4 publications

References 27 publications

Computed Tomography Study of the Retrosigmoid Craniotomy Keyhole Approach Using Surface Landmarks

Computed Tomography Study of the Retrosigmoid Craniotomy Keyhole Approach Using Surface Landmarks

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

Localización preoperatoria de la trepanación inicial en el abordaje retrosigmoideo. Revisión de literatura y aplicación quirúrgica

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