Posterior Petrous Meningiomas: Surgical Classification and Postoperative Outcomes in a Case Series of 130 Patients Operated via the Retrosigmoid Approach

Donofrio, Carmine Antonio; Badaloni, Filippo; Riccio, Lucia; Morandini, Alessandro; Bertuccio, Alessandro; Generali, Daniele; Calbucci, Fabio; Servadei, Franco; Fioravanti, Antonio

doi:10.1016/j.wneu.2022.12.022

Cited by 1 publication

(1 citation statement)

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“…The PCS is located medially to the pcICA and turns inferolaterally toward the jugular foramen, accommodating the inferior petrosal sinus [26][27][28]. The PA of the temporal bone is pyramidal and is composed of the apex, which points anteromedially and confines anteromedially with the posteroinferior portion of the cavernous sinus and posterolaterally with the trigeminal nerve; the base, which is directed posterolaterally and is delimited by a virtual line passing through the anterior border of the internal acoustic meatus; the superior surface, part of the middle cranial fossa floor laterally bordered by the horizontal segment of the ptICA, the anterior genu of the pcICA and the FL, and the inferior surface, the anterior third of the posterior petrous bone surface that joins at the petrous ridge, where the superior petrosal sinus courses [8,27,28].…”

Section: Surgical Anatomy Considerationsmentioning

confidence: 99%

Combined Endoscopic Endonasal Transclival and Contralateral Transmaxillary Approach to the Petrous Apex and the Petroclival Synchondrosis: Working “Around the Corner” of the Internal Carotid Artery—Quantitative Anatomical Study and Clinical Applications

Donofrio,

Corrivetti,

Riccio

et al. 2024

JCM

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The endoscopic contralateral transmaxillary (CTM) approach has been proposed as a potential route to widen the corridor posterolateral to the internal carotid artery (ICA). In this study, we first refined the surgical technique of a combined multiportal endoscopic endonasal transclival (EETC) and CTM approach to the petrous apex (PA) and petroclival synchondrosis (PCS) in the dissection laboratory, and then validated its applications in a preliminary surgical series. The combined EETC and CTM approach was performed on three cadaver specimens based on four surgical steps: (1) the nasal, (2) the clival, (3) the maxillary and (4) the petrosal phases. The CTM provided a “head-on trajectory” to the PA and PCS and a short distance to the surgical field considerably furthering surgical maneuverability. The best operative set-up was achieved by introducing angled optics via the endonasal route and operative instruments via the transmaxillary corridor exploiting the advantages of a non-coaxial multiportal surgery. Clinical applications of the combined EETC and CTM approach were reported in three cases, a clival chordoma and two giant pituitary adenomas. The present translational study explores the safety and feasibility of a combined multiportal EETC and CTM approach to access the petroclival region though different corridors.

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