Evolution of the posterior petrosal approach

Gross, Bradley A.; Tavanaiepour, Daryoush; Du, Rose; Al‐Mefty, Ossama; Dunn, Ian F.

doi:10.3171/2012.6.focus12133

Cited by 21 publications

(9 citation statements)

References 37 publications

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“…a modified strategy for the transpetrosal approaches that avoids sectioning the sinus. [48][49][50][51][52] Hafez et al 50 obtained adequate exposure of petroclival tumors with the transpetrosal approaches by detaching the superior petrosal sinus from the petrous ridge rather than occluding and dividing it.…”

Section: Superior Petrosal Sinusmentioning

confidence: 99%

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Matsushima

Kuga

et al. 2014

Operative Neurosurgery

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The superior petrosal veins and their largest tributaries, especially the vein of the cerebellopontine fissure, should be preserved if possible. Obliteration of superior petrosal sinuses in which either the lateral or medial portion is absent may result in loss of the drainage pathway of the superior petrosal veins. Preoperative assessment of the superior petrosal sinus should be considered before transpetrosal surgery in which the superior petrosal sinus may be obliterated.

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Section: Superior Petrosal Sinusmentioning

confidence: 99%

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Matsushima

Kuga

et al. 2014

Operative Neurosurgery

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“…[38920] To avoid sacrificing the superior petrosal sinus in the presigmoid approach, Hafez et al . [9] detatched the sinus from the petrous ridge and were thus able to access petroclival tumors.…”

Section: Discussionmentioning

confidence: 99%

Absence of the superior petrosal veins and sinus: Surgical considerations

Matsushima¹,

Ribas²,

Kiyosue³

et al. 2015

Surg Neurol Int

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Background:The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups.Methods:This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent.Results:The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface.Conclusions:In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes.

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“…9 Although the risk of complications increases markedly with the more aggressive transotic and transcochlear variants, in the hands of an experienced neurootologist, the relative risk to the facial nerve function of a posterior petrosectomy or translabyrinthine operation is equivocal, as compared with a retrosigmoid craniotomy with intradural opening of the IAC. [20][21][22][23][24][25]…”

Section: Anatomical Comparison To the Presigmoid Approachesmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Retrosigmoid Approach

Graffeo

Peris-Celda

Perry

et al. 2019

J Neurol Surg B Skull Base

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Introduction Neurosurgical anatomy is traditionally taught via anatomic and operative atlases; however, these resources present the skull base using views that emphasize three-dimensional (3D) relationships rather than operative perspectives, and are frequently written above a typical resident's understanding. Our objective is to describe, step-by-step, a retrosigmoid approach dissection, in a way that is educationally valuable for trainees at numerous levels. Methods Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A retrosigmoid was performed by each of three neurosurgery residents, under supervision by the senior authors (C.L.W.D. and M.J.L.) and a graduated skull base fellow, neurosurgeon, and neuroanatomist (M.P.C.). Dissections were supplemented with representative case applications. Results The retrosigmoid craniotomy (aka lateral suboccipital approach) affords excellent access to cranial nerve (CN) IV to XII, with corresponding applicability to numerous posterior fossa operations. Key steps include positioning and skin incision, scalp and muscle flaps, burr hole and parasigmoid trough, craniotomy flap elevation, initial durotomy and deep cistern access, completion durotomy, and final exposure. Conclusion The retrosigmoid craniotomy is a workhorse skull base exposure, particularly for lesions located predominantly in the cerebellopontine angle. Operatively oriented neuroanatomy dissections provide trainees with a critical foundation for learning this fundamental skull base technique. We outline a comprehensive approach for neurosurgery residents to develop their familiarity with the retrosigmoid craniotomy in the cadaver laboratory in a way that simultaneously informs rapid learning in the operating room, and an understanding of its potential for wide clinical application to skull base diseases.

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Evolution of the posterior petrosal approach

Cited by 21 publications

References 37 publications

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Absence of the superior petrosal veins and sinus: Surgical considerations

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Retrosigmoid Approach

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