A standalone minimally invasive presigmoid retrolabyrinthine suprameatal approach: A cadaveric morphometric study.

Surgical neurology international Pub Date : 2025-02-28 eCollection Date: 2025-01-01 DOI:10.25259/SNI_1110_2024
Samer S Hoz, Paolo Palmisciano, Ahmed Muthana, Edward J Doyle Iii, Mark D Johnson, Mustafa Ismail, Jonathan A Forbes, Charles J Prestigiacomo, Ravi Samy, Mario Zuccarello, Norberto Andaluz
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Abstract

Background: Presigmoid approaches provide access to several structures anterior to the sigmoid sinus (SS) and may be intended for the treatment of lesions located in the middle and posterior fossa. We conducted a morphometric cadaveric study investigating the infratentorial presigmoid retrolabyrinthine suprameatal approach (PRSA) as a unique operative corridor. The typical anatomic-radiological characteristics and variations were evaluated and analyzed to predict surgical accessibility.

Methods: A total of 10 surgical dissections were performed on both sides of five adults, injected, and cadaveric heads. Fifteen morphometric parameters were measured, analyzed, and categorized into pre-procedural, intra-procedural, and additional parameters.

Results: Preoperative anatomic-radiological parameters provide valuable information to select patients with favorable anatomy that may offer appropriate surgical accessibility to the medial part of cerebellopontine angle cistern, lateral pons, and prepontine cistern through a PRSA corridor. An obtuse petroclival angle of ≥144° with a more horizontally oriented petrous bone, a posterior SS position, and a large mastoid cavity provided the greatest surgical accessibility through the PRSA corridor. The superior petrosal sinus drainage and the degree of petrous apex pneumatization were important factors affecting surgical fluency and speed. However, they were not determinant factors for selecting the most appropriate patients eligible for the PRSA.

Conclusion: The PRSA represents a minimally invasive modification of the trans-labyrinthine approach that may be offered in patients with lesions medial to the internal auditory canal or anterior/lateral to the brainstem, with the goal of preserving vestibulocochlear functions. Preoperative anatomic-radiological parameters are mandatory for a patient-tailored selection of the most effective surgical approach.

一种独立的微创乙状结肠前迷路后板膜上入路:尸体形态计量学研究。
背景:乙状结肠前入路可进入乙状结肠窦(SS)前方的几个结构,可用于治疗位于中窝和后窝的病变。我们进行了一项形态学尸体研究,探讨了幕下乙状结肠前迷路后上膜入路(PRSA)作为一种独特的手术通道。对典型的解剖-放射学特征和变异进行评估和分析,以预测手术可及性。方法:对5例成人、注射头和尸体头部进行了10例手术解剖。测量、分析了15个形态计量参数,并将其分为术前、术中和附加参数。结果:术前解剖学-影像学参数为选择解剖结构良好的患者提供了有价值的信息,这些患者可以通过PRSA通道对桥小脑角池内侧、桥外侧和桥前池进行适当的手术。钝岩斜角≥144°,石质骨更水平定向,后侧SS位和大乳突腔提供了通过PRSA通道的最大手术可达性。岩上窦引流和岩尖通气程度是影响手术流畅性和速度的重要因素。然而,它们并不是选择最合适的患者进行PRSA的决定因素。结论:PRSA是经迷路入路的一种微创改良方法,可用于内耳道内侧或脑干前/外侧病变的患者,目的是保留前庭耳蜗功能。术前解剖-放射学参数是强制性的,为患者量身定制的选择最有效的手术方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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