Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region

Jun Muto, Daniel M. Prevedello, Leo F.S.Ditzel Filho, Ing Ping Tang, Kenichi Oyama, Edward E. Kerr, Bradley A. Otto, Takeshi Kawase, Kazunari Yoshida, Ricardo L. Carrau

研究成果: Article

26 引用 (Scopus)

抜粋

Objective The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. methods On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. results Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. conclusions The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.

元の言語English
ページ(範囲)1171-1186
ページ数16
ジャーナルJournal of Neurosurgery
125
発行部数5
DOI
出版物ステータスPublished - 2016 11 1

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

フィンガープリント Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region' の研究トピックを掘り下げます。これらはともに一意のフィンガープリントを構成します。

  • これを引用

    Muto, J., Prevedello, D. M., Filho, L. F. S. D., Tang, I. P., Oyama, K., Kerr, E. E., Otto, B. A., Kawase, T., Yoshida, K., & Carrau, R. L. (2016). Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region. Journal of Neurosurgery, 125(5), 1171-1186. https://doi.org/10.3171/2015.8.JNS15302