Endoscopic Subtemporal Epidural Key-Hole Approach: Quantitative Anatomic Analysis of Three Surgical Corridors.

Adult Cadaver Cranial Fossa, Middle / pathology Craniotomy / methods Epidural Space / pathology Humans Neuroendoscopy / methods
Anatomy Endoscopy Key-hole Preclinical Quantification Subtemporal

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
08 2021
Historique:
received: 09 03 2021
revised: 14 05 2021
accepted: 14 05 2021
pubmed: 26 5 2021
medline: 21 10 2021
entrez: 25 5 2021
Statut: ppublish

Résumé

The endoscope-assisted subtemporal key-hole epidural approach (ESKEA) has been recently described. The aim of this study was to measure working volumes and exposure of key areas of the middle cranial fossa provided by this approach. Four fresh frozen cadaver heads were dissected to analyze 3 modular corridors (1A, 1B, and 2) harvested through ESKEA. A step-by-step dissection was performed, and key anatomic landmarks were recorded. A GTxEyesII-ApproachViewer was used to quantify the working volume and exposure of 4 different regions (sphenoorbital, parasellar, superior petrous apex, and squamopetrous). For each corridor, 3 incremental degrees of temporal dural retraction (5, 10, and 15 mm) were tested. The working volume of all corridors progressively increased with degree of retraction: Corridors 1A, 1B, and 2 showed a gain in working volume of 21%, 27%, and 19% from 5 mm to 10 mm retraction, respectively, and a gain of 40%, 45%, and 44% from 5 mm to 15 mm retraction, respectively. The sphenoorbital area was exposed (27%-45%) through corridor 1A, and exposure significantly increased with the degree of retraction. Corridor 1B provided optimal exposure of parasellar areas (86%-100%) and superior petrous apex (70%-87%) regardless of the degree of retraction. The squamopetrous area was satisfactorily addressed through corridor 2 (88%) only with the highest degree of retraction. ESKEA can be conceived as a modular approach: the 3 surgical corridors have specific working volumes, which are clearly influenced by the degree of temporal lobe retraction, and provide exposure of different middle cranial fossa areas.

Sections du résumé

BACKGROUND
The endoscope-assisted subtemporal key-hole epidural approach (ESKEA) has been recently described. The aim of this study was to measure working volumes and exposure of key areas of the middle cranial fossa provided by this approach.
METHODS
Four fresh frozen cadaver heads were dissected to analyze 3 modular corridors (1A, 1B, and 2) harvested through ESKEA. A step-by-step dissection was performed, and key anatomic landmarks were recorded. A GTxEyesII-ApproachViewer was used to quantify the working volume and exposure of 4 different regions (sphenoorbital, parasellar, superior petrous apex, and squamopetrous). For each corridor, 3 incremental degrees of temporal dural retraction (5, 10, and 15 mm) were tested.
RESULTS
The working volume of all corridors progressively increased with degree of retraction: Corridors 1A, 1B, and 2 showed a gain in working volume of 21%, 27%, and 19% from 5 mm to 10 mm retraction, respectively, and a gain of 40%, 45%, and 44% from 5 mm to 15 mm retraction, respectively. The sphenoorbital area was exposed (27%-45%) through corridor 1A, and exposure significantly increased with the degree of retraction. Corridor 1B provided optimal exposure of parasellar areas (86%-100%) and superior petrous apex (70%-87%) regardless of the degree of retraction. The squamopetrous area was satisfactorily addressed through corridor 2 (88%) only with the highest degree of retraction.
CONCLUSIONS
ESKEA can be conceived as a modular approach: the 3 surgical corridors have specific working volumes, which are clearly influenced by the degree of temporal lobe retraction, and provide exposure of different middle cranial fossa areas.

Identifiants

DOI: 10.1016/j.wneu.2021.05.055 PMID: 34033959
pubmed: 34033959
pii: S1878-8750(21)00750-6
doi: 10.1016/j.wneu.2021.05.055
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e128-e137

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Auteurs

Vittorio Rampinelli (V)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy. Electronic address: vittorio.rampinelli@gmail.com.

Edoardo Agosti (E)

Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Giorgio Saraceno (G)

Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Marco Ferrari (M)

Section of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Stefano Taboni (S)

Section of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Davide Mattavelli (D)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Alberto Schreiber (A)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Michele Tomasoni (M)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Tommaso Gualtieri (T)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Marco Ravanelli (M)

Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Barbara Buffoli (B)

Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Rita Rezzani (R)

Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Marco Maria Fontanella (MM)

Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Piero Nicolai (P)

Section of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Cesare Piazza (C)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Alberto Deganello (A)

Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Francesco Doglietto (F)

Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Mort › Cadavre › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › Appareil locomoteur › Squelette › Crâne › Base du crâne › Fosse crânienne moyenne › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Craniotomie › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › Appareil locomoteur › Squelette › Rachis › Canal vertébral › Espace épidural › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Endoscopic Subtemporal Epidural Key-Hole...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Neuroendoscopie › Endoscopic Subtemporal Epidural Key-Hole...