Extended Anterior Petrosectomy Through the Transcranial Middle Fossa Approach and Extended Endoscopic Transsphenoidal-Transclival Approach: Qualitative and Quantitative Anatomic Analysis

Hasanbelliu, Aurel; Andaluz, Norberto; Somma, Alberto Di; Keller, Jeffrey T.; Zimmer, Lee A.; Samy, Ravi N.; Pensak, Myles L.; Zuccarello, Mario

doi:10.1016/j.wneu.2020.02.127

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…RSMTA and Kawase's ASTA conceptually use the same surgical corridor as bone resection is almost identical in both approaches and RSMTA have even be defined as "anterior petrosectomy from below." 20 It has also been emphasized that RSMTA is the counterpart of the ASTA because both approaches can "target the same area" via separate surgical corridors, with the RSMTA being called as an "inverted Kawase's approach," when dealing with the petrous apex and Meckel cave. 1,17,20 In this vein, several anatomic studies compared two approaches to calculate the exposure along the brainstem and the amount of bone removal.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus

Polat

Çamlar

Bilgin

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Surgical approaches to the ventral brainstem and petroclival regions are complex, and standard retrosigmoid and subtemporal approaches are often inadequate. Retrosigmoid suprameatal tubercle (RSMTA) and anterior subtemporal transpetrosal (ASTA) approaches may provide extended surgical exposure with less brain retraction. The objective of this study was to evaluate advantages and disadvantages of RSMTA vs ASTA, and illustrate the surgical corridors and 3-dimensional microsurgical anatomy of the related structures. METHODS: Four silicone-injected adult cadaver heads (8 sides) were dissected to evaluate the accessibility of lesions located at the petrous apex, ventral brainstem, and pontomedullary region using ASTA and RSTMA. RESULTS: Both ASTA and RSMTA provide access from the petrous apex to the ventral lower pons and pontomedullary junction. A greater extent of safely resected bone was found in ASTA vs RSMTA. ASTA provides a larger surgical view to the ventrolateral midpons, peritrigeminal region, superior neurovascular complex, pontomesencephalic junction, and posterior cavernous sinus. Meanwhile, through cranial nerve V mobilization, RSMTA provides a larger surgical view to the lower half part of the pons, ventrolateral part of the pontomedullary junction, and middle and lower neurovascular structures. CONCLUSION: The choice of surgical approach is determined by considering the area where the lesion originates, lesion size, the anatomic structures to which it extends, and evaluation of the area that can be surgically exposed. Our study highlights the differences between these approaches and important surgical anatomic considerations.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus

Polat

Çamlar

Bilgin

et al. 2023

Operative Neurosurgery

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“…Previous studies comparing the anterior petrosectomy and the EEA to petrosectomy used different techniques and therefore reached varied results. Hasanbelliu et al 9 used an extended endoscopic transsphenoidal transclival approach which included the drilling away of bone that covered the paraclival ICA to mobilize the ICA. However, the effect of the bone removal was small, and therefore the EEA technique for bone removal in this study was comparable to that of the MP in our study.…”

Section: Discussionmentioning

confidence: 99%

“…However, surgical terminology, definitive surgical techniques, landmarks, advantages, and limitations of each approach remain ill defined. [4][5][6][7][8][9] Technical mastery is critical for the safe performance of these approaches.…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers

Loymak

Belykh

Abramov

et al. 2022

J Neurol Surg B Skull Base

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Objectives Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies. Design This study presents anatomical dissection and quantitative analysis. Setting Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques. Participants Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides. Main Outcomes and Measures Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume. Results The IMP technique provided a greater area of exposure (p < 0.01) and bone resection volume (p < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique (p < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [p = 0.04], anterior inferior cerebellar artery [p < 0.01], proximal part of the cisternal CN VI segment [p = 0.02]) and IP (flocculus [p = 0.02] and the proximal [p = 0.02] and distal parts [p = 0.02] of the CN VII/VIII complex) techniques. Conclusion Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques.

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“…Studies have reported the use of the EEA in the cadaveric anatomical study of petroclival lesions. [21,18,10,19,33] However, the surgical approach to petroclival lesions cannot be generalized for every patient. Extradural lesions, including bone lesions, are more suitably operated using EEA.…”

Section: Suitability Of Craniotomy or Endoscopic Endonasal Surgery Fo...mentioning

confidence: 99%

Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study

Adachi

Hasegawa

Hirose

2023

Preprint

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The efficacy of spinal drain (SD) placement for cerebrospinal fluid (CSF) leakage prevention after anterior transpetrosal approach (ATPA) remains unclear. Thus, we aimed to assess whether postoperative SD placement improved postoperative CSF leakage after a skull base reconstruction procedure using a small abdominal fat and pericranial flap and clarify whether bed rest with postoperative SD placement increased the length of hospital stay. This retrospective cohort study included 48 patients who underwent primary surgery using ATPA between November 2011 and February 2022. First, we evaluated the necessity of SD placement for CSF leakage prevention by comparing the routine SD placement period to a period in which the SD was removed immediately after surgery. Second, the effects of different SD placement durations were evaluated to understand the adverse effects of SD placement requiring bed rest. No patient with or without SD placement developed CSF leakage. The median postoperative time to first ambulation was 3 days shorter (P < 0.05) and the length of hospital stay was 7 days shorter (P < 0.05) for patients who underwent SD removal immediately after surgery (2 and 12 days, respectively) than for those who underwent SD removal on postoperative day 1 (5 and 19 days, respectively). This skull base reconstruction technique was effective in preventing CSF leakage in patients undergoing ATPA, and postoperative SD placement was not necessary. Removing the SD immediately after surgery can lead to earlier postoperative ambulation and shorter hospital stay by reducing medical complications and improving functional capacity.

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Extended Anterior Petrosectomy Through the Transcranial Middle Fossa Approach and Extended Endoscopic Transsphenoidal-Transclival Approach: Qualitative and Quantitative Anatomic Analysis

Cited by 10 publications

References 29 publications

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus

Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers

Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study

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