Precise Localization in Craniotomy With a Retrosigmoid Keyhole Approach: Microsurgical Anatomy and Clinical Study

Jian, Zhi-heng; Sheng, Minfeng; Li, Jiayan; Liu, Yu; Weng, Zhijian; Chen, Gang

doi:10.3389/fsurg.2022.809098

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…In our study, we observed that the distance from the TMN to the IM point was found to be 19.2 mm (16.1; 23.2) cranially. Jian et al suggested that the exact location of the burr hole should be 12 mm directly above the highest point of the mastoid groove [ 5 ]. So, considering that the burr hole cover has a diameter of 14 mm, the upper boundary of the burr hole would be approximately 0.2 cm away from the IM point of the TSSJ according to our study.…”

Section: Discussionmentioning

confidence: 99%

“…There have been several efforts to pinpoint the anatomical markers that represent the TSSJ. Superficial reference points of the cranium, including the asterion, the superior nuchal line, the line connecting the inion, and the root of the zygomatic arch are employed to identify significant intracranial structures [ 5 ]. To summarize, the approaches have the following drawbacks: firstly, there are instances where the skull sutures cannot be clearly distinguished, resulting in ineffective localization of the TSSJ.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical Landmarks for Transverse-Sigmoid Sinus Junction: A Cadaveric Study

Jurgaitis,

Jukna,

Terbetas

2024

Cureus

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Background and objective: Accurately identifying and avoiding crucial anatomical structures within the posterior cranial fossa using superficial landmarks is essential for reducing surgical complications. Our study focuses on the top of the mastoid notch (TMN) as an external landmark of the cranium, aiming to assist in the strategic placement of the initial burr hole. In this study, we present a method for predicting the path of the transverse sinus (TS) and explore the relationship between the junction of the transverse-sigmoid sinus and the TMN. Methods: Following anatomical dissections of the brain in cadaveric specimens, we conducted intracranial drilling from the inside surface of the cranium on 10 adult skulls (20 sides). A coordinate system was established on the posterolateral surface of the skull to assist the analysis. Using a self-leveling laser level, we set up a horizontal Frankfurt line (X-axis) and identified a vertical perpendicular line passing through the TMN to serve as the Y-axis. To identify the course of the TS, we divided the segment between the two inferomedial points into six equidistant points along the Frankfurt line. Results: No significant difference was observed between the inferomedial points of the transverse-sigmoid sinus junction (TSSJ) on the left and right sides. The inferomedial point was positioned at a median of 6.6 mm (Q1: 3.7 mm, Q3: 9.4 mm) dorsally and at a median of 19.2 mm (Q1: 16.1 mm, Q3: 23.2 mm) cranially from the TMN. The upper edge of the TS was located at distances of 6.4 mm (5.7; 12.7), 10.3 mm (8.8; 12.3), and 13.8 mm (11.9; 16.3) on the right, and 4.9 mm (4.1; 7.9), 8.6 mm (7.6; 13.0), and 12.8 mm (11.7; 17.5) on the left side from the Frankfurt horizontal plane at the ¼, ½, and ¾ line points, respectively. The bottom edge was positioned at distances of 0.6 mm (-2.7; 2.0), 2.1 mm (-0.8; 3.8), and 4.8 mm (2.4; 6.7) on the right, and 1.1 mm (-3.4; 2.4), 2.0 mm (0.2; 4.8), and 3.9 mm (3.7; 5.3) on the left from these respective points. The upper edge of the right TS was found to be statistically more distant from the Frankfurt horizontal plane at the ¼ line point (p-value = 0.027) compared to that on the left side. The confluence of the sinus center was identified as having a median distance of 7.8 mm (4.5; 8.3) and an inferior point of 1.5 mm (0.1; 3.0) cranially to the inion. In all examined bodies (n = 10), the confluens sinuum was consistently 4.7 mm (3.3; 5.6) to the right in relation to the inion. Notably, the median of the right transverse sinus diameter (median = 9.3 mm) was found to be significantly larger than that of the left transverse sinus (median = 7.0), with a statistically significant p-value of 0.048. Conclusions: The literature regarding the external identification of the TSSJ and the course of the TS varies. In our efforts to provide a description, we have utilized the TMN as a reliable landmark for locating the TSSJ. To delineate the trajectory of the TS after its exit from the confluence of sinuses, we...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomical Landmarks for Transverse-Sigmoid Sinus Junction: A Cadaveric Study

Jurgaitis,

Jukna,

Terbetas

2024

Cureus

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“… 11 , 12 , 14 Furthermore, although plain CT is widely utilized as a preoperative imaging modality for MVD to obtain anatomical information about the mastoid air cells, CTA can also provide essential information on the transverse sinus and sigmoid sinus location, which is important for lateral suboccipital craniotomy. 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

Utilization of three-dimensional fusion images with high-resolution computed tomography angiography for preoperative evaluation of microvascular decompression: patient series

Iwata,

Hosomi,

Tani

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND High-resolution computed tomography (CT), outfitted with a 0.25-mm detector, has superior capability for identifying microscopic anatomical structures compared to conventional CT. This study describes the use of high-resolution computed tomography angiography (CTA) for preoperative microvascular decompression (MVD) assessment and explores the potential effectiveness of three-dimensional (3D) image fusion with magnetic resonance imaging (MRI) by comparing it with traditional imaging methods. OBSERVATIONS Four patients who had undergone preoperative high-resolution CTA and MRI for MVD at Osaka University Hospital between December 2020 and March 2022 were included in this study. The 3D-reconstructed images and intraoperative findings were compared. One patient underwent conventional CTA, thus allowing for a comparison between high-resolution and conventional CTA in terms of radiation exposure and vascular delineation. Preoperative simulations reflected the intraoperative findings for all cases; small vessel compression of the nerve was identified preoperatively in two cases. LESSONS Compared with conventional CTA, high-resolution CTA showed superior vascular delineation with no significant change in radiation exposure. The use of high-resolution CTA with reconstructed 3D fusion images can help to simulate prior MVD. Knowing the location of the nerves and blood vessels can perioperatively guide neurosurgeons.

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“…The localization of the posterior aspect of the SS and the transverse-sigmoid junction is extensively studied compared to the paucity of signs focusing on the presigmoid territory. [ 3 , 5 ] In addition, the constant refinement of the presigmoid approaches to achieve minimal invasiveness renders the new modified minimally invasive approaches to have shorter incisions and focused skin incisions. This will shrink the exposed bony surface and lessen the accessible surface or skeletal anatomical indicators.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the variability of this landmark in terms of age, gender, or racial characteristics can be validated in the future studies. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

The crux of helix curvature: A potential surface landmark for the anterior border of the sigmoid sinus in minimally invasive presigmoid approaches

Hoz

Palmisciano

Algburi

et al. 2022

Surgical Neurology International

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Background: Surgical landmarks are widely used across all surgical specialties to assist surgeons in accurately estimating the deep anatomical structures. We describe the crus of helix curvature as a potential indicator for the anterior border of the sigmoid sinus (SS) in the setting of minimally invasive presigmoid approaches. Methods: Anatomy investigations were performed on injected cadaveric heads to identify consistent surface surgical landmarks estimating the curse of the SS. Results: Presigmoid mastoid was noted in the center of the skin incision in 100% of the specimens. The crus of helix curvature was superimposed on the anterior border of the SS on 6 sides (60%). On the other four sides, the curvature lays within 5 mm of the anterior SS border (40%). Conclusion: For the minimally invasive presigmoid approaches, the “crus of helix curvature” can be used as a landmark for the anterior border of the SS, which can aid in the speed and safety of the procedure. The ease of use of this landmark makes it particularly convenient for physicians early in training.

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Precise Localization in Craniotomy With a Retrosigmoid Keyhole Approach: Microsurgical Anatomy and Clinical Study

Cited by 5 publications

References 22 publications

Anatomical Landmarks for Transverse-Sigmoid Sinus Junction: A Cadaveric Study

Anatomical Landmarks for Transverse-Sigmoid Sinus Junction: A Cadaveric Study

Utilization of three-dimensional fusion images with high-resolution computed tomography angiography for preoperative evaluation of microvascular decompression: patient series

The crux of helix curvature: A potential surface landmark for the anterior border of the sigmoid sinus in minimally invasive presigmoid approaches

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