Postauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails

Behari, Sanjay; Tyagi, Isha; Banerji, Deepu; Kumar, Vijendra; Jaiswal, Awadhesh Kumar; Phadke, Rajendra V.; Jain, Vibha

doi:10.1007/s00701-010-0701-y

Cited by 29 publications

(32 citation statements)

References 17 publications

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“…BulGulAr: Ön üçgenler için hesaplanan projeksiyon alanı yüzdesinde bir fark görülmedi (EPTT, %21,5±12,5; ST, %28,8±14,9; p=0,1948) ama arka üçgenler için önemli bir fark bulundu (EPTT, %74,0±4,5; ST, %51,5±4,3; p<0,01). ST yaklaşımıyla karşılaştırıldığında EPTT yaklaşımı orta kraniyal fossada eşdeğer projeksiyon yapılmış alan yüzdesi ve posterior kraniyal fossada daha büyük bir açığa çıkarılmış alan sağladı.…”

Section: Discussionunclassified

“…It can not only ensure larger exposure and shorter distance, but also provide remarkable assistance to reduce the retraction of the temporal lobe and preserves the integrity of Labbe's vein (1,3,20,29). However, the disadvantages such as being time-consuming, the extensive destruction of the skull base, the high risk of neurological deficits and CSF leakage lead to slow recovery (Table II).…”

Section: Comparison Of the Percentage Of Projected Areamentioning

confidence: 99%

“…The tumors in the petroclival region are always benign and slowgrowing. Therefore, when patients with petroclival tumors have clinical symptoms and go to see a doctor, the tumors have already grown to a large or giant volume and usually extend anteriorly from the dorsum sellae to the parasellar region and cavernous sinus, and posteriorly from the ventral brainstem to the lower clivus and foramen magnum (25) (3). The III~XII cranial nerves, basilar artery (BA) and its important branches such as the posterior cerebral artery (PCA) and superior cerebellar artery (SCA), and the petrous segment of the internal carotid artery (ICA) all go through this region.…”

Section: Introductionmentioning

confidence: 99%

“…Kafa tabanında sırasıyla anterior ve posterior petroklival bölgede bulunan yan yana iki üçgen oluşturmak üzere dört adet derin kemik anatomik referans noktası belirlendi. İki yaklaşımın sağladığı derin ekspojuru karşılaştırmak üzere gerçek, projeksiyon yapılmış alan ve projeksiyon yapılmış alanın yüzdesi belirlendi ve hesaplandı.BulGulAr: Ön üçgenler için hesaplanan projeksiyon alanı yüzdesinde bir fark görülmedi (EPTT, %21,5±12,5; ST, %28,8±14,9; p=0,1948) ama arka üçgenler için önemli bir fark bulundu (EPTT, %74,0±4,5; ST, %51,5±4,3; p<0,01). ST yaklaşımıyla karşılaştırıldığında EPTT yaklaşımı orta kraniyal fossada eşdeğer projeksiyon yapılmış alan yüzdesi ve posterior kraniyal fossada daha büyük bir açığa çıkarılmış alan sağladı.…”

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Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

Tang

Wang²,

Ma³

et al. 2014

Turkish Neurosurgery

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AIm:The anatomic characters and applicability of the extended pterional transtemporal transtentorial (EPTT) approach versus the subtemporal transtentorial (ST) approach for surgical treatment of petroclival tumors were evaluated. mATErIAl and mEThOds: Ten sides from five adult Chinese injected cadavers were manipulated using both two approaches. Four deep bony anatomic landmarks were specified in the skull base to create two adjoining triangles that were respectively located in the anterior and posterior petroclival region. The real, projected area and the percentage of the projected area were determined and calculated to compare the deep exposure from the two approaches.rEsulTs: There was no difference regarding the percentage of the projected area was calculated in the anterior triangles (EPTT, 21.5±12.5%; ST, 28.8±14.9%; p=0.1948), but a significant difference was present in the posterior triangles (EPTT, 74.0±4.5%; ST, 51.5±4.3%; p<0.01). Compared with the ST approach, the EPTT approach provides an equivalent percentage of projected area in the middle cranial fossa and a wider exposed area in the posterior cranial fossa. CONClusION:Through anatomic comparative analysis the EPTT approach provides better exposure and is more appropriate than the ST approach for large and giant petroclival tumors predominantly in the posterior cranial fossa with extensive invasion to parasellar structures and the cavernous sinus.KEywOrds: Anatomic study, Petroclival region, Pterional approach, Subtemporal approach, Skull base ÖZ AmAÇ: Petroklival tümörlerin cerrahi tedavisi için genişletilmiş pterional transtemporal transtentorial (EPTT) yaklaşımı ile subtemporal transtentorial (ST) yaklaşımının anatomik özellikleri ve uygulanabilirliği karşılaştırmalı olarak değerlendirildi. yÖNTEm ve GErEÇlEr: Her iki yaklaşım kullanılarak beş yetişkin Çinli kadavra çift taraflı olarak açıldı ve incelendi. Kafa tabanında sırasıyla anterior ve posterior petroklival bölgede bulunan yan yana iki üçgen oluşturmak üzere dört adet derin kemik anatomik referans noktası belirlendi. İki yaklaşımın sağladığı derin ekspojuru karşılaştırmak üzere gerçek, projeksiyon yapılmış alan ve projeksiyon yapılmış alanın yüzdesi belirlendi ve hesaplandı.BulGulAr: Ön üçgenler için hesaplanan projeksiyon alanı yüzdesinde bir fark görülmedi (EPTT, %21,5±12,5; ST, %28,8±14,9; p=0,1948) ama arka üçgenler için önemli bir fark bulundu (EPTT, %74,0±4,5; ST, %51,5±4,3; p<0,01). ST yaklaşımıyla karşılaştırıldığında EPTT yaklaşımı orta kraniyal fossada eşdeğer projeksiyon yapılmış alan yüzdesi ve posterior kraniyal fossada daha büyük bir açığa çıkarılmış alan sağladı. sONuÇ: Karşılaştırmalı analiz yoluyla EPTT yaklaşımının temel olarak posterior kraniyal fossada bulunan ve parasellar yapılar ve kavernöz sinüse yaygın invazyon yapmış büyük ve dev petroklival tümörler için ST yaklaşımına göre daha fazla görüş alanı sağladığı ve daha uygun olduğu ortaya çıktı.

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Section: Discussionunclassified

Section: Comparison Of the Percentage Of Projected Areamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

unclassified

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Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

Tang

Wang²,

Ma³

et al. 2014

Turkish Neurosurgery

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“…The postauricular, transpetrous and presigmoid approaches combine a supra/ infratentorial exposure with partial petrosectomy to access the third to twelfth cranial nerves and the anterolateral to the brainstem. It provides a shorter working distance to the large petrosal, petroclival, cerebellopontine and cerebellomedullary cisternal lesions (5). The microanatomy for surgery on the superior petroclival region through the frontotemporal-zygomatic arch approach remains unclear (6).…”

Section: Introductionmentioning

confidence: 99%

Microsurgical anatomical study of the frontotemporal-zygomatic arch approach to the superior petroclival region

Zhou

Zhen

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to explore the microsurgical anatomy of the superior petroclival region, and thus provide an anatomical basis for operative approaches. The frontotemporal-orbitozygomatic approach was performed on 20 sides of 10 adult cadaver heads. In comparison to the range of the exposure with the removal of the anterior clinoid process, posterior clinoid process and part of the tip of the petrous bone, we measured the neurovascular course and their relation to the superior petroclival region. We found that the trochlear nerve goes through the edge of the tentorial marginal branch, taking 5.42 mm (4.26-6.96) away from the ophthalmic nerve. Exposing the arteria basilaris, above the middle piece the length of exposure is 15.52 mm (14.22-16.70), resulting in the posterior cerebral artery and the front part of the midbrain being completely exposed. There is little exposure on the front part of the pons and midbrain with a length of 5.6 mm (4.38-6.82). Removing the partial petrosal bones, the inferior segment of the basal artery is exposed, while 4 other nerves cab also be observed: Cranial, abducens, facial and vestibulocochlear. The frontotemporal-zygomatic arch approach can clearly expose the superior petroclival region. Obtaining more information on the relationship between the location of these structures, is therefore helpful in improving the safety and success of surgery in this region.

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Trautmann's triangle anatomy with application to posterior transpetrosal and other related skull base procedures

et al. 2014

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Trautmann's triangle (TT) faces the cerebellopontine angle and is exposed during posterior transpetrosal approaches. However, reports on the morphometric analysis of this structure are lacking in the literature. The goal was to better understand this important operative corridor. TT was exposed from an external approach (transmastoid) in ten cadavers (20 sides) and from an internal approach on 20 dry adult temporal bones. Measurements included calculation of the area of TT and the distance of the endolymphatic sac from the anterior border of the sigmoid sinus. The area range of TT was 45-210 mm(2) (mean 151 mm(2); SD 37 mm(2)). Three types of triangles were identified based on area. Type I triangles had areas less than 75 mm(2), Type II areas were 75-149 mm(2), and Type III areas were 150 mm(2) and greater. These types were observed in 37.5%, 35%, and 27.5% of sides, respectively. The distance from the jugular bulb's anterior border to the posterior border of the posterior semicircular canal ranged from 6 to 11 mm (mean 8.5 mm). The endolymphatic sac was located in the inferior portion of TT and traveled anterior to the sigmoid sinus. The horizontal distance from the anterior edge of the sigmoid sinus to the posterior edge of the endolymphatic sac ranged from 0 to 13.5 mm (mean 9 mm). Additional anatomic knowledge regarding TT may improve neurosurgical procedures in this region by avoiding intrusion into the endolymphatic sac and sigmoid sinus.

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Postauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails

Cited by 29 publications

References 17 publications

Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region

Microsurgical anatomical study of the frontotemporal-zygomatic arch approach to the superior petroclival region

Trautmann's triangle anatomy with application to posterior transpetrosal and other related skull base procedures

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