Background/objective: The inframeatal area represents a challenging region for skull base surgeons. Various surgical corridors have been described to access this area and frequently are used in combination. Recent studies describe the expanded endoscopic endonasal approach (EEA) as an established route for midline regions, particularly medial to the internal carotid arteries (ICA). We sought to evaluate the accessibility, maneuverability, and freedom of movement of the expanded endoscopic endonasal approach to the inframeatal region.
Methods: An EEA combining a middle and an inferior transclival corridor with an infrapetrous and a supracondylar lateral expansion was performed in 5 embalmed human cadaveric heads. The area of exposure and the surgical freedom to access the inframeatal area were calculated. The angle of attack and distances from the lacerum segment of the ICA to several anatomical targets also were measured. Our database was searched to select clinical case examples.
Results: The EEA provided an exposure area of 101.26 ± 16.66 mm and an area of surgical freedom of 1208.50 ± 507.01 mm. The angles of attack in both the sagittal and axial planes were wider at the lacerum segment of the ICA and narrower at the dural entrance zone of cranial nerves VII/VIII. Three chondrosarcomas are presented as case illustrations.
Conclusions: The EEA is a feasible route to the inframeatal area. This approach provides a safe working corridor for lesions in this region, as shown by the anatomical and clinical findings presented here. Comparative studies and large case series are warranted to further establish its clinical value.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.wneu.2018.09.052 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
A proposed classification system for presigmoid approaches: a scoping review.
J Neurosurg
October 2023
Departments of1Neurosurgery and.
Objective: The "presigmoid corridor" covers a spectrum of approaches using the petrous temporal bone either as a target in treating intracanalicular lesions or as a route to access the internal auditory canal (IAC), jugular foramen, or brainstem. Complex presigmoid approaches have been continuously developed and refined over the years, leading to great heterogeneity in their definitions and descriptions. Owing to the common use of the presigmoid corridor in lateral skull base surgery, a simple anatomy-based and self-explanatory classification is needed to delineate the operative perspective of the different variants of the presigmoid route.
View Article and Find Full Text PDFQuantitative Comparative Analysis of the Endoscope-Assisted Expanded Retrosigmoid Approach and the Far-Lateral Approach to the Inframeatal Area: An Anatomic Study With Surgical Implications.
Oper Neurosurg (Hagerstown)
March 2023
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
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.
Expanded Endoscopic Endonasal Approach to the Inframeatal Area: Anatomic Nuances with Surgical Implications.
World Neurosurg
December 2018
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA. Electronic address:
Background/objective: The inframeatal area represents a challenging region for skull base surgeons. Various surgical corridors have been described to access this area and frequently are used in combination. Recent studies describe the expanded endoscopic endonasal approach (EEA) as an established route for midline regions, particularly medial to the internal carotid arteries (ICA).
View Article and Find Full Text PDFFunctional Petrosectomy Via a Suboccipital Retrosigmoid Approach: Guidelines and Topography.
World Neurosurg
March 2016
Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA. Electronic address:
Objective: Recent reports have validated the use of retrosigmoid approach extensions to deal with posterior fossa lesions extending laterally extracranially or superiorly into the petroclival areas. The purpose of our research is to describe the topographic retrosigmoid anatomy of the petrous pyramid and provide guidelines for neurovascular sparing drilling (hence for a functional petrosectomy), via this surgical route.
Methods: Suprameatal and inframeatal retrosigmoid approach extensions were performed bilaterally in 6 specimens in the semisitting position.
Microsurgical and endoscopic anatomy of the extended retrosigmoid inframeatal infratemporal approach.
Neurosurgery
March 2015
*Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery and ¶Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio; ‡Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; §International Neuroscience Institute, Hannover, Germany.
Background: Different and often complex routes are available to deal with jugular foramen tumors with extracranial extension.
Objective: To describe a novel extension of the retrosigmoid approach useful to expose the extracranial area abutting the posterior fossa skull base.
Methods: A navigation-guided, endoscope-assisted retrosigmoid inframeatal approach was performed on 6 cadaveric heads in the semisitting position, displaying an area from the internal acoustic meatus to the lower cranial nerves and exposing the intrapetrous internal carotid artery.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!