The Subtemporal Interdural Approach to Dumbbell-Shaped Trigeminal Schwannomas: Cadaveric Prosection

Youssef, Samy; Kim, Eun Young; Aziz, Khaled; Hemida, Salah A; Keller, Jeffrey T.; Loveren, Harry R. van

doi:10.1227/01.neu.0000227590.70254.02

Cited by 48 publications

(56 citation statements)

References 31 publications

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“…On the other hand, the endoscope provides a close-up view of the lesion, with capability of looking around the corners and, when angulated lenses are used, of providing a panoramic view of the surrounding area. 17,18 Theoretically, one would stand to gain by combining the advantages of both technologies. Yet, in real practice this has not been the case.…”

Section: Discussion Endoscope-assisted Microneurosurgery: the Currentmentioning

confidence: 99%

“…Also, we performed the subtemporal approaches bilaterally in all the cadavers targeting the tip of the basilar artery and its main trunk, the origin of the superior cerebellar arteries and posterior cerebral arteries, and the mamillary bodies. [12][13][14][15][16][17] Every dissection was conducted first with the microscope alone and then with the microscope aided by the endoscope and neuronavigation. When the endoscope was used ,we injected the endoscopic view and the neuronavigation view into the microscope oculars in real time using the BiOpix system.…”

Section: Surgical Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

Salma

Ammirati

2011

Skull Base

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).Endoscopes and neuronavigation systems are becoming more and more popular as adjunctive tools during microscopic neurosurgical operations. 1-11 However, the current integration of the endoscope or the neuronavigation system in a microneurosurgical environment is still based on what can be described as a serial combination. This type of combination is not ergonomically efficient due to the need of changing the visual field of the operating surgeon from the microscopic image displayed in the microscope oculars to the endoscopic images displayed on the endoscopy monitor, or to the neuronavigation's screen. A more ergonomically efficient combination of these imaging platforms is what could be called the parallel integration, where about these image modalities are displayed simultaneously and at will on a single main viewing platform.In this report, we tested and analyzed, in a cadaveric model, the technical features and the potential applicability of a new way of integrating the microscope, the endoscope, and the neuronavigation; in a parallel fashion by utilizing a new technology, the BiOpix (CCA Medical, Milford, OH) high definition (HD) picture-in-picture image injection system. This new technology allows parallel combination of the endoscope and microscope by allowing real-time display of high-resolution endoscopic and/or neuronavigation images in both microscope oculars, thus theoretically making the use of the endoscope and of the neuronavigation system more efficient and more ergonomic during microsurgery. Materials and Methods Preparation of Cadaveric HeadsWe used six fresh cadaver heads injected with colored silicone, and implanted with eight adhesive scalp fiducials. The specimens then underwent computed tomographic imaging using the following protocol: slice thickness, 1-mm, Keywords► endoscope ► image-guided surgery ► microneurosurgery ► medical technology ► skull base surgery Abstract Endoscope, microscope, and neuronavigation systems are integrated in neurosurgical procedures mainly by using a serial combination algorithm, where, the user must switch his/her field of view from one platform display to another. The integration of theses devices could be optimized by incorporating different displays into one viewing platform thus achieving a parallel combination. In this study, we investigated the feasibility and the applicability of parallel integration of microscopic, endoscopic, and neuronavigation images by real time displaying the endoscope and neuronavigation image datasets in the main operative microscope oculars. The proposed set-up was effective in displaying the three images dataset in an operationally actionable mode. Ergonomically, the ability of using the different image dataset without the need of taking the eyes off the microscope oculars did not disrupt the flow or the tempo of the operative procedure. However, new endoscopes specific to this application are recommended.

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Section: Discussion Endoscope-assisted Microneurosurgery: the Currentmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

Salma

Ammirati

2011

Skull Base

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“…Studies have been carried out to describe the meningeal anatomy related to this approach as well as the dural incisions, to develop a subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas that effectively converts a multiple-compartment tumor into a single-compartment tumor (14). By removing the petrous apex of the temporal bone and zygomatic arch, doctors could achieve greater exposure.…”

Section: Discussionmentioning

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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“…The extension of bone removal depends on the extension of the tumor and is limited by the otic capsule. This approach achieves an anterior direct view of brain stem and cerebellopontine angle 2,14,15) . Moreover, this approach may reduce some disadvantages, such as long operation time, high risk of facial palsy, hearing loss, and cerebrospinal fluid leakage 6) .…”

Section: Tailored Petrosectomymentioning

confidence: 99%

Surgery for a Case of Three-Compartment Trigeminal Schwannoma : Technical Aspects

Chung

Kim

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 48 : [383][384][385][386][387] 2010 Complete removal of three-compartment trigeminal schwannomas is a challenge to neurosurgeons. To expand exposure of each compartment, the combination and modification of skull base approaches are necessary. The 61-year-old woman was admitted with chronic headache. Preoperative magnetic resonance imaging showed 47×50×40 mm-sized tumor originating primarily in the middle cranial fossa extended to the posterior and the infratemporal fossa. We performed operation in five stage; 1. Zygomatic osteotomy, 2. Inferior temporal fossa plate removal and foramen ovale opening, 3. Cavernous sinus opening, 4. Tailored anterior petrosectomy, 5. Meckel's cave opening. Combination of skull base surgery should be concerned according to the patient. In this study, extradural basal extension with zygomatic osteotomy, interdural posterior extension with tailored anterior petrosectomy, and intracavernous exploration are reasonable options for remodeling three-compartment lesion into a single compartment. Tailoring of bone resection and exploring through natural pathway between meningeal layers accomplish single-stage operation for complete removal of tumors.

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The Subtemporal Interdural Approach to Dumbbell-Shaped Trigeminal Schwannomas: Cadaveric Prosection

Cited by 48 publications

References 31 publications

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

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

Surgery for a Case of Three-Compartment Trigeminal Schwannoma : Technical Aspects

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