Quantitative Comparative Analysis of the Endoscope-Assisted Expanded Retrosigmoid Approach and the Far-Lateral Approach to the Inframeatal Area: An Anatomic Study With Surgical Implications.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
received:
07
07
2022
accepted:
07
09
2022
pubmed:
27
1
2023
medline:
18
2
2023
entrez:
26
1
2023
Statut:
ppublish
Résumé
The inframeatal area (IFMA) is a complex anatomic region of the posterior cranial fossa. Given its deep-seated location, tumors involving the IFMA represent a surgical challenge. To objectively compare the endoscope-assisted expanded retrosigmoid approach (ERSA) and the far-lateral supracondylar transtubercular approach (FLTA) to address the IFMA. Anatomic dissections were performed on 5 cadaveric heads (10 sides). The ERSAs were performed before and after the FLTAs. The surgical exposure, surgical freedom, and angles of attack to the IFMA were measured and compared for each approach. In addition, 2 illustrative clinical cases are reported. Compared with FLTA, ERSA yielded a nonsignificantly smaller mean area of exposure, whereas FLTA provided a significantly larger mean area of surgical freedom, compared with ERSA ( P = .002). The mean horizontal and vertical angles of attack were significantly different between the approaches. In the vertical plane, FLTA yielded the broadest angle of attack at the root entry zone of the lower cranial nerves (CN; P < .004), whereas ERSA did so at the dural entry zone of CN VII/VIII ( P = .006). In the horizontal plane, FLTA achieved its broadest angle of attack at the root entry zone of the lower CNs ( P = 1.83) while ERSA at the dural entry zone of CN VII/VIII ( P = .37). ERSA and FLTA granted a comparable exposure with the IFMA. Although FLTA may afford a larger area of surgical freedom, ERSA may be a suitable alternative to approach the IFMA, particularly to reach the most medial and superior aspects of this region. Conversely, FLTA may facilitate access to more caudally targets.
Sections du résumé
BACKGROUND
The inframeatal area (IFMA) is a complex anatomic region of the posterior cranial fossa. Given its deep-seated location, tumors involving the IFMA represent a surgical challenge.
OBJECTIVE
To objectively compare the endoscope-assisted expanded retrosigmoid approach (ERSA) and the far-lateral supracondylar transtubercular approach (FLTA) to address the IFMA.
METHODS
Anatomic dissections were performed on 5 cadaveric heads (10 sides). The ERSAs were performed before and after the FLTAs. The surgical exposure, surgical freedom, and angles of attack to the IFMA were measured and compared for each approach. In addition, 2 illustrative clinical cases are reported.
RESULTS
Compared with FLTA, ERSA yielded a nonsignificantly smaller mean area of exposure, whereas FLTA provided a significantly larger mean area of surgical freedom, compared with ERSA ( P = .002). The mean horizontal and vertical angles of attack were significantly different between the approaches. In the vertical plane, FLTA yielded the broadest angle of attack at the root entry zone of the lower cranial nerves (CN; P < .004), whereas ERSA did so at the dural entry zone of CN VII/VIII ( P = .006). In the horizontal plane, FLTA achieved its broadest angle of attack at the root entry zone of the lower CNs ( P = 1.83) while ERSA at the dural entry zone of CN VII/VIII ( P = .37).
CONCLUSION
ERSA and FLTA granted a comparable exposure with the IFMA. Although FLTA may afford a larger area of surgical freedom, ERSA may be a suitable alternative to approach the IFMA, particularly to reach the most medial and superior aspects of this region. Conversely, FLTA may facilitate access to more caudally targets.
Identifiants
pubmed: 36701685
doi: 10.1227/ons.0000000000000506
pii: 01787389-202303000-00025
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e187-e200Informations de copyright
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
Références
Samii M, Metwali H, Samii A, Gerganov V. Retrosigmoid intradural inframeatal approach: indications and technique. Oper Neurosurg. 2013;73(1 suppl operative):ONS53-ONS59; discussion ONS60.
Revuelta Barbero JM, Noiphithak R, Yanez-Siller JC, et al. Expanded endoscopic endonasal approach to the inframeatal area: anatomic nuances with surgical implications. World Neurosurg. 2018;120:e1234-e1244.
Rhoton AL Jr. The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. Neurosurgery. 2000;47(suppl_3):S93-S129.
Raza SM, Quinones-Hinojosa A. The extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification. Neurosurg Rev. 2011;34(1):123-129.
Matsushima K, Komune N, Matsuo S, Kohno M. Microsurgical and endoscopic anatomy for intradural temporal bone drilling and applications of the electromagnetic navigation system: various extensions of the retrosigmoid approach. World Neurosurg. 2017;103:620-630.
Samii M, Alimohamadi M, Gerganov V. Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors. J Neurosurg. 2016;124(4):1061-1067.
Colasanti R, Tailor ARA, Gorjian M, Zhang J, Ammirati M. Microsurgical and endoscopic anatomy of the extended retrosigmoid inframeatal infratemporal approach. Oper Neurosurg. 2015;11(1):181-189; discussion 189.
Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg. 1986;64(4):559-562.
Velat GJ, Spetzler RF. The far-lateral approach and its variations. World Neurosurg. 2012;77(5-6):619-620.
Russo VM, Graziano F, Quiroga M, Russo A, Albanese E, Ulm AJ. Minimally invasive supracondylar transtubercular (MIST) approach to the lower clivus. World Neurosurg. 2012;77(5-6):704-712.
Alvernia JE, Pradilla G, Mertens P, Lanzino G, Tamargo RJ. Latex injection of cadaver heads: technical note. Oper Neurosurg. 2010;67(2 suppl operative):362-367.
Elhadi AM, Almefty KK, Mendes GA, et al. Comparison of surgical freedom and area of exposure in three endoscopic transmaxillary approaches to the anterolateral cranial base. J Neurol Surg B Skull Base. 2014;75(05):346-353.
Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery. 2002;50(3):550-557; discussion 555-557.
Basma J, Nguyen V, Sorenson J, Michael L. Extended retrosigmoid approach for the resection of a pontomedullary junction cavernous malformation. J Neurol Surg Part B Skull Base. 2018;79(suppl 5):S418-S419.
Ceylan D, Tatarli N, Seker A, Cavdar S, Kilic T. Surgical exposure gained in an extended retrosigmoid approach to the cerebellopontine angle compared to the traditional retrosigmoid approach. Turk Neurosurg. 2015;25(5):728-736.
Rhoton AL Jr. The temporal bone and transtemporal approaches. Neurosurgery. 2000;47(suppl_3):S211-S265.
Sanna M, Pandya Y, Mancini F, Sequino G, Piccirillo E. Petrous bone cholesteatoma: classification, management and review of the literature. Audiol Neurotol. 2011;16(2):124-136.
Ammirati M, Ma J, Canalis R, et al. A combined intradural presigmoid-transtransversarium-transcondylar approach to the whole clivus and anterior craniospinal region: anatomic study. Skull Base. 1993;3(04):193-200.
Tomio R, Horiguchi T, Borghei-Razavi H, Tamura R, Yoshida K, Kawase T. Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications. J Neurosurg. 2022;136(2):413-421.
Devèze A, Franco-Vidal V, Liguoro D, Guérin J, Darrouzet V. Transpetrosal approaches for meningiomas of the posterior aspect of the petrous bone Results in 43 consecutive patients. Clin Neurol Neurosurg. 2007;109(7):578-588.
Sato Y, Mizutani T, Shimizu K, Freund HJ, Samii M. Retrosigmoid intradural suprameatal-inframeatal approach for complete surgical removal of a giant recurrent vestibular schwannoma with severe petrous bone involvement: technical case report. World Neurosurg. 2018;110:93-98.
Matsushima K, Kohno M, Nakajima N, et al. Retrosigmoid intradural suprajugular approach to jugular foramen tumors with intraforaminal extension: surgical series of 19 cases. World Neurosurg. 2019;125:e984-e991.
Ma L, Shrestha BK, You C, Hui X. Revisiting the far lateral approach in the treatment of lesions located at the craniocervical junction—experiences from West China hospital, Sichuan University, Chengdu. Interdiscip Neurosurg. 2015;2(3):133-138.
Carl H, Snyderman PAG. Master Techniques in Otolaryngology: Heade and Neck Surgery—Otology, Neurotology, and Lateral Skull Base Surgery. Lippincott, Williams & Wilkins; 2019.
Moscovici S, Umansky F, Spektor S. “Lazy” far-lateral approach to the anterior foramen magnum and lower clivus. Neurosurg Focus. 2015;38(4):E14.
Vaz-Guimaraes F, Gardner PA, Fernandez-Miranda JC. Endoscope-assisted retrosigmoid approach for cerebellopontine angle epidermoid tumor. J Neurol Surg B Skull Base. 2018;79(suppl 05):S409-S410.
Lynch JC, Gonçalves MB, Pereira CE, Welling L. Lateral suboccipital retrosigmoid retrocondylar approach for foramen magnum meningiomas. J Craniovertebr Junction Spine. 2018;9(3):175-181.
Luzzi S, Giotta Lucifero A, Bruno N, Baldoncini M, Campero A, Galzio R. Far lateral approach. Acta Biomed. 2022;92(S4):e2021352.
de Notaris M, Cavallo LM, Prats-Galino A, et al. Endoscopic endonasal transclival approach and retrosigmoid approach to the clival and petroclival regions. Oper Neurosurg. 2009;65(6):ONS42-ONS52; discussion 50-52.
Benet A, Prevedello DM, Carrau RL, et al. Comparative analysis of the transcranial “far lateral” and endoscopic endonasal “far medial” approaches: surgical anatomy and clinical illustration. World Neurosurg. 2014;81(2):385-396.
Zwirner J, Scholze M, Ondruschka B, Hammer N. Tissue biomechanics of the human head are altered by Thiel embalming, restricting its use for biomechanical validation. Clin Anat. 2019;32(7):903-913.