Microsurgical and Endoscopic Anatomy of the Retrosigmoid Intradural Suprameatal Approach to Lesions Extending from the Posterior Fossa to the Central Skull Base

 

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ABSTRACT

This article evaluates the accessibility of the posterior part of the central skull base via the extended retrosigmoid intradural suprameatal approach. In formaldehyde-fixed specimens, the retrosigmoid intradural suprameatal approach was performed, and the feasibility of reaching central skull base structures was analyzed. Microscopic and endoscopic techniques were used. The main outcome measures were digital films and screenshots, which were analyzed regarding quantitative and qualitative aspects of visual structures. By drilling off the suprameatal tubercle and part of the petrous apex, Meckel's cave may be opened, the trigeminal nerve mobilized, and the tentorium divided. Thus the parasellar area may be exposed and the posterosuperior space of the cavernous sinus approached. Using an endoscope-assisted technique and following cisternal anatomy, the sellar and parasellar region may be explored even if the working space is narrow. The retrosigmoid intradural suprameatal approach provides optimal accessibility to medially located central skull base structures, in particular to the posterior part of the cavernous sinus. Use of the endoscope may remarkably optimize the accessibility.

REFERENCES

• 1 Samii M, Tatagiba M, Carvalho G A. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome.  J Neurosurg. 2000;  92 235-241
  CrossrefPubMedGoogle Scholar
• 2 Seoane E, Rhoton Jr A L. Suprameatal extension of the retrosigmoid approach: microsurgical anatomy.  Neurosurgery. 1999;  44 553-560
  CrossrefPubMedGoogle Scholar
• 3 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions.  J Neurosurg. 1983;  58 824-831
  CrossrefPubMedGoogle Scholar
• 4 Dolenc V V. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms.  J Neurosurg. 1985;  62 667-672
  PubMedGoogle Scholar
• 5 Dolenc V V. Frontotemporal epidural approach to trigeminal neurinomas.  Acta Neurochir (Wien). 1994;  130 55-65
  CrossrefPubMedGoogle Scholar
• 6 Bambakidis N C, Kakarla U K, Kim L J et al.. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review.  Neurosurgery. 2007;  61 202-209
  PubMedGoogle Scholar
• 7 Little A S, Jittapiromsak P, Crawford N R et al.. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension.  Neurosurgery. 2008;  62(5 Suppl 2) ONS318-ONS323
  PubMedGoogle Scholar
• 8 Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique.  Surg Neurol. 1986;  26 271-276
  CrossrefPubMedGoogle Scholar
• 9 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients.  Neurosurgery. 1991;  28 869-875
  CrossrefPubMedGoogle Scholar
• 10 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches.  Neurosurgery. 2006;  59 1019-1028
  CrossrefPubMedGoogle Scholar
• 11 Laufer I, Anand V K, Schwartz T H. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions.  J Neurosurg. 2007;  106 400-406
  CrossrefPubMedGoogle Scholar
• 12 Samii M, Tatagiba M, Carvalho G A. Resection of large petroclival meningiomas by the simple retrosigmoid route.  J Clin Neurosci. 1999;  6 27-30
  CrossrefPubMedGoogle Scholar
• 13 Tatagiba M, Samii M, Matthies C, Vorkapic P. Management of petroclival meningiomas: a critical analysis of surgical treatment.  Acta Neurochir Suppl (Wien). 1996;  65 92-94
  PubMedGoogle Scholar
• 14 Koerbel A, Kirschniak A, Ebner F H, Tatagiba M, Gharabaghi A. The retrosigmoid intradural suprameatal approach to posterior cavernous sinus - Microsurgical anatomy.  Eur J Surg Oncol. 2008;  , April 2 (Epub ahead of print)
  PubMedGoogle Scholar
• 15 Ebner F H, Koerbel A, Kirschniak A, Roser F, Kaminsky J, Tatagiba M. Endoscope-assisted retrosigmoid intradural suprameatal approach to the middle fossa: anatomical and surgical considerations.  Eur J Surg Oncol. 2007;  33 109-113
  CrossrefPubMedGoogle Scholar
• 16 Koerbel A, Gharabaghi A, Safavi-Abbasi S et al.. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas.  Eur J Surg Oncol. 2008;  , April 21 (Epub ahead of print)
  PubMedGoogle Scholar

Florian H EbnerM.D. 

Department of Neurosurgery, Eberhard-Karls-University, Hoppe-Seyler-Street 3

72076 Tübingen, Germany

Email: florianebner@virgilio.it