Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach

Silva, Erasmo Barros da; Leal, André Giacomelli; Milano, Jerônimo Buzetti; Silva, Luis F. Moura da; Clemente, Rogério; Ramina, Ricardo

doi:10.1007/s00701-009-0553-5

Cited by 76 publications

(61 citation statements)

References 17 publications

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“…Current advances in image-rendering have made it possible to generate 3D models by reconstructing image data and perform precise morphometric investigation in vivo (3,5,6,11). Using 64 bilateral measurements obtained in 32 Chinese patients, we performed a morphometric study on the location of the asterion.…”

Section: █ Discussionmentioning

confidence: 99%

“…Recent advances in 3D-computed tomography (CT) volume rendering techniques have made it possible to visualize minute bone sutures and venous structures of the posterior fossa (3,5,6,11).…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in 3D-computed tomography (CT) volume rendering techniques have made it possible to visualize minute bone sutures and venous structures of the posterior fossa (3,5,6,11).The purpose of this study is to determine the anatomic position of the asterion and the transverse-sigmoid sinus junction in Chinese population using the root of the zygoma and the tip of the mastoid process as palpable points. We also tried to clarify the relationship between the asterion and the inferior aspect of the transverse-sigmoid sinus junction using a 3D-CT procedure in vivo (8).…”

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confidence: 99%

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Skull anatomic landmarks for retrosigmoid craniotomy in a chinese cohort: a 3D-CT study in vivo

Fan

Chen²,

Wang³

et al. 2013

Turkish Neurosurgery

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ABSTRACTas a surgical landmark has been questioned (8). Recent advances in 3D-computed tomography (CT) volume rendering techniques have made it possible to visualize minute bone sutures and venous structures of the posterior fossa (3,5,6,11).The purpose of this study is to determine the anatomic position of the asterion and the transverse-sigmoid sinus junction in Chinese population using the root of the zygoma and the tip of the mastoid process as palpable points. We also tried to clarify the relationship between the asterion and the inferior aspect of the transverse-sigmoid sinus junction using a 3D-CT procedure in vivo (8). █ MATERIAL and METHODSThe Zhejiang University ethics committee approval to fulfill the █ INTRODUCTIONThe correct location of an initial strategic burr hole for a retrosigmoid craniotomy to give access to the cerebellopontine angle (CPA) is paramount in obtaining optimal exposure in this region (12).As the transverse and sigmoid sinuses are the natural limits of these exposures, a knowledge about their cranial topography constitutes the main factor in the planning of these retrosigmoid approaches (10). The asterion serves as the junction of the lambdoid, parietomastoid and occipitomastoid sutures, and has been used in retrosigmoid craniotomy to locate the transverse-sigmoid sinus junction (2, 9, 12-14).As cadaveric studies have shown considerable variability in the relationship of the asterion to the underlying venous structures and its population-specific variability, its validity AIM: This study was designed to determine the anatomic position of the asterion and the relationship between the asterion and the transverse sigmoid sinus junction (TSSJ) in a Chinese cohort. MATERIAL and METHODS:Venous computed tomography (CT) angiography was performed in 32 patients to simultaneously obtain 3D-CT volume rendering images of the cranial bone and the dural sinus. The relationship between the TSSJ and the asterion was analyzed. RESULTS:The distance from the asterion to root of zygoma (ROZ) was 54.6 ± 5.50 mm on the right side and 54.1 ± 5.42 mm on the left side. The asterion was 49.10 ± 3.56 mm above the tip of mastoid process (TOP) on the right side and 48.70 ± 2.23 mm on the left side. The asterion's position was at the junction of the transverse-sigmoid sinus complex in 44 cases, below it in 19 cases, and above it in one case.CONCLUSION: 3D-CT volume rendering imaging is capable of accurately and simultaneously visualizing the bony landmark and the dural sinus structure outline in vivo, thus offering a new option for anatomic research and morphometric investigation. The accurate location of asterion can be found using the root of the zygoma and the tip of the mastoid process.

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Section: █ Discussionmentioning

confidence: 99%

“…Recent advances in 3D-computed tomography (CT) volume rendering techniques have made it possible to visualize minute bone sutures and venous structures of the posterior fossa (3,5,6,11).…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Skull anatomic landmarks for retrosigmoid craniotomy in a chinese cohort: a 3D-CT study in vivo

Fan

Chen²,

Wang³

et al. 2013

Turkish Neurosurgery

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“…The translation value in assessing individual relations of the asterion and transverse/sigmoid sinus junction in retrosigmoid craniotomies was demonstrated by multiple studies [18][19][20]. Our previous analysis of neuronavigation data from surgical phantoms [21] and operative cases [22] for surgical corridor size in the eyebrow craniotomy showed a good correlation between the simulations and intraoperative results.…”

Section: Radioanatomical Simulations Of Surgical Approachesmentioning

confidence: 98%

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

et al. 2017

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Object Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as Bx^, and the distance from the coronal suture in the sagittal plane represented as By^. The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results The distance of the optimal ETV entry point from the Bregma in the coronal plane (Bx^) and from the coronal suture in the sagittal plane (By^) correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR−13.3 (r 2 = 0.84, p < 0.001) and y = −69.6 FHR + 16.7 (r 2 = 0.83, p < 0.001). Conclusion The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.

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“…After registration of navigation parameters the transverse and sigmoid sinuses were drawn over the skin. MRI-guided navigation accurately identifies the position of the transverse and sigmoid sinus, reducing the rates of venous injury during the retrosigmoid craniotomy 15 . The cerebellomedullary cistern was drained and the cerebellopontine angle exposed through the retrosigmoid approach.…”

Section: Intraoperative Measurements (Stage 2)mentioning

confidence: 99%

Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation

Leal

Silva

Ramina³

2015

Arq. Neuro-Psiquiatr.

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Objective Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). Method Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. Results The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. Conclusion A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals.

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Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach

Cited by 76 publications

References 17 publications

Skull anatomic landmarks for retrosigmoid craniotomy in a chinese cohort: a 3D-CT study in vivo

Skull anatomic landmarks for retrosigmoid craniotomy in a chinese cohort: a 3D-CT study in vivo

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation

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