Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach-technical case report

Shinya Ichimura, Kazunari Yoshida, Hiroshi Kagami, Makoto Inaba, Maaya Orii, Yohei Kitamura, Isako Saga, Masahiro Toda

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

The drainage of the superficialmiddle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV. We report a case in which modified surgical procedures via the ATPA were used to preserve the SBV. A 45-year-old man complained of right facial pain. Magnetic resonance images revealed a right cerebellopontine tumor suggestive of an epidermoid cyst. Right carotid angiography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. The convexity dura mater of the temporal lobe was cut and the anterior part of the temporal lobe was retracted subdurally. The SBV was visualized from the subdural side. The basal dura mater of the temporal lobe posterior to the SBV was cut and the posterior part of the temporal lobe was retracted epidurally. After dissecting the dura mater medial to the greater petrosal nerve and to the edge of the petrous apex, the petrous apex was exposed and drilled out without injuring the SBV. The superior petrous sinus and the tentorium were cut. The tumor compressed the root exit zone of the trigeminal nerve. The tumor was grossly totally removed. ThemodifiedATPA (epidural anterior petrosectomy with subdural visualization of the SBV) is effective in preserving the SBV.

Original languageEnglish
Pages (from-to)609-614
Number of pages6
JournalNeurosurgical Review
Volume35
Issue number4
DOIs
Publication statusPublished - 2012 Oct

Keywords

  • Anterior transpetrosal approach
  • Epidural anterior petrosectomy
  • Pterygoid plexus
  • Sphenobasal vein
  • Subdural visualization

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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