Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Incidence and Risk Factors for Postoperative Pulmonary Complications in Endoscopic Skull Base Surgery.","authors":"Nana-Hawwa Abdul-Rahman, Carl H Snyderman","doi":"10.1055/a-2531-2417","DOIUrl":"10.1055/a-2531-2417","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the incidence and risk factors for postoperative pulmonary complications (PPCs) following endoscopic endonasal surgery (ESS).</p><p><strong>Design: </strong>Retrospective review from January 2023 to May 2023.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Participants: </strong>One hundred EES cases, of which 97 met the inclusion criteria.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of PPC. Univariable and multivariable analyses were used to assess preoperative variables, demographics, and respiratory comorbidities; intraoperative variables of surgery and duration of intubation, endotracheal tube (ETT) size, estimated blood loss (EBL), gastric tube use during surgery; postoperative cerebrospinal fluid (CSF) leak, and length of hospital stay as predictors of PPC.</p><p><strong>Results: </strong>Ninety-seven patients met the inclusion criteria. Twenty-nine developed PPC including increased oxygen requirement (14.4%), pneumonia (9.3%), atelectasis (3.1%), respiratory failure (2.1%), and pulmonary embolism (2.1%). Sixty-four percent were clinically significant PPC. PPC was associated with age ( <i>p</i>  < 0.007), longer duration of surgery ( <i>p</i>  < 0.001), longer duration of intubation ( <i>p</i>  < 0.001), postoperative intubation ( <i>p</i>  < 0.001), higher EBL ( <i>p</i>  = 0.022), and longer length of hospital stay ( <i>p</i>  < 0.001). There was no significant association between PPC and sex ( <i>p</i>  = 0.705), body mass index (BMI; <i>p</i>  = 0.403), gastric tube presence ( <i>p</i>  = 0.778), ETT size ( <i>p</i>  = 0.636), and preoperative history of pulmonary disease ( <i>p</i>  = 0.403).</p><p><strong>Conclusion: </strong>The incidence of PPC in patients undergoing EES is significant. Targeting perioperative risk factors including age ≥65, duration of intubation, postsurgical intubation status, and intraoperative blood loss should have a meaningful impact on decreasing PPC. The contribution of silent intraoperative aspiration during surgery needs to be investigated further in high-risk patient populations.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"50-56"},"PeriodicalIF":0.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Guide to Intracranial Bypass Suture.","authors":"Sonia Ajmera, Svetlana Kvint, Christopher S Graffeo, Ronald R Barbosa, Visish M Srinivasan","doi":"10.1055/a-2531-2506","DOIUrl":"10.1055/a-2531-2506","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrovascular bypass surgery is technically demanding, with dozens of modifiable parameters influencing operative decision-making. Thoughtful selection of needle and suture materials is critical to success in these operations.</p><p><strong>Methods: </strong>Based on the authors' experiences and existing literature, a brief guide to needle and suture selection is provided.</p><p><strong>Results: </strong>Recommendations for needle and suture have taken into consideration key features of bypass constructs, such as bypass type, vessel caliber, and working space. Specific suture and needle are highlighted from two of the most common industry suppliers.</p><p><strong>Conclusion: </strong>This guide synthesizes clinical insights and practical guidelines to support neurosurgical trainees and practitioners in mastering cerebrovascular bypass techniques.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"84-87"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Role of Intraoperative Prolactin Levels in Surgical Management of Prolactinomas: Predicting Operative Success and Enhancing Surgical Decision-Making.","authors":"Salomon Cohen-Cohen, Giorgos Michalopoulos, Irina Bancos, Lucinda M Gruber, Carlos D Pinheiro Neto, Jamie J Van Gompel","doi":"10.1055/a-2531-2446","DOIUrl":"10.1055/a-2531-2446","url":null,"abstract":"<p><strong>Objective: </strong>Prolactinomas comprise half of all pituitary adenomas. This study explores the significance of measuring intraoperative (IO) prolactin (PRL) levels in guiding surgical decision-making and predicting operative success.</p><p><strong>Methods: </strong>Retrospective cohort study design of consecutive patients with prolactinomas who underwent transsphenoidal resection from June 2021 to May 2023. IO PRL was measured after tumor resection was completed. Remission was defined as normalization of PRL levels during follow-up without medication. Outcomes included factors associated with remission, utilizing significance thresholds at <i>p</i>  < 0.05.</p><p><strong>Results: </strong>Thirteen patients were included with a 5.3-month median follow-up (range, 3-15 months). Most of the tumors were microadenomas (61%), with a median preoperative PRL level of 116 ng/mL (range, 25-471). Gross total resection was achieved in 69% of patients, all of whom attained remission. The median IO PRL was 19.8 ng/mL (range, 1-329), the postoperative day 1 PRL of 3.6 ng/mL (range, 1-203), and the latest PRL at 9.3 ng/mL (range, 1-137). A ≥40% decline in IO PRL from baseline was identified as the optimal cutoff for predicting biochemical remission, with 89% sensitivity, 75% specificity, and 85% accuracy.</p><p><strong>Conclusion: </strong>Monitoring PRL levels intraoperatively may be a useful biomarker aiding surgeon's assessment of the extent of tumor resection and guide surgical decision-making. Further refinement of the immunoassay assay and clinical testing with more extensive prospective studies are needed.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"88-93"},"PeriodicalIF":0.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Artificial Dura for Anterior Skull Base Reconstruction Following Transcranial Resection of Benign Cranionasal Communicating Tumors: Technical Note.","authors":"Junhua He, Bo Wang, Xingchao Wang, Peng Li, Mingtian Liuge, Zhixu Bie, Jie Yin, Zhiyong Bi, Pinan Liu","doi":"10.1055/a-2531-2566","DOIUrl":"10.1055/a-2531-2566","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to introduce a watertight duraplasty with artificial dural grafts for anterior skull base (ASB) reconstruction.</p><p><strong>Methods: </strong>Between November 2019 and October 2023, we used artificial dural grafts for the ASB reconstruction in 10 cases of recurrent benign cranionasal communicating tumors. Through a transcranial subfrontal approach, the tumor was totally removed and the skull base defect was repaired using the NormalGEN and DuraMax artificial dural grafts. Clinical and imaging follow-ups were conducted to screen for the occurrence of postoperative cerebrospinal fluid (CSF) leakage, intracranial infection, and encephalocele.</p><p><strong>Results: </strong>Gross total resection of tumor and ASB reconstruction with the artificial dural grafts were achieved in 10 patients. The patients were followed up clinically for 11 to 52 months (mean 26.0 months) and underwent medical imaging follow-up for 6 to 36 months (mean 18.4 months). One patient presented with CSF leakage on day 47 after the operation. Another patient endured intracranial infection without CSF leakage on the fifth day after the operation. Both patients were cured. No encephalocele was observed during the follow-up period. All the patients achieved a favorable recovery.</p><p><strong>Conclusion: </strong>Following transcranial resection of benign cranionasal communicating tumors, we utilized artificial dural grafts for ASB reconstruction when the frontal pericranium was impaired by tumor invasion or previous surgery. Our initial experience and postoperative follow-up have proven that the method is feasible and reliable in selected cases.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"e1-e10"},"PeriodicalIF":0.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Endoscopic and Open Cranial Approach for Treatment of Skull Base Lesions: A Case Series and Lessons Learned.","authors":"Elsa Olson, Bradley Kolb, Lucinda Chiu, Russell Whitehead, Tamara Simpson, Peter C Revenaugh, Ryan Smith, Peter Filip, Peter Papagiannopoulos, Bobby A Tajudeen, Pete S Batra, Stephan A Munich","doi":"10.1055/a-2531-2328","DOIUrl":"10.1055/a-2531-2328","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment of skull base pathologies is frequently discussed in the context of endoscopic endonasal or transcranial approaches. Combined endoscopic and open approaches have been utilized in a staged or sequential fashion, with the goal of reducing the risk of postoperative cerebrospinal fluid leak, morbidity, wound infection/complication, and failure to achieve adequate reconstruction. However, few studies have described the concurrent use of endoscopic endonasal and transcranial approaches to safely address complex skull base pathologies.</p><p><strong>Methods: </strong>We treated 13 patients with primary skull base tumors (sinonasal undifferentiated carcinoma/esthesioneuroblastoma), recurrent tumors, infection, and skull base defect/encephalocele. Out of the thirteen patients, eight had undergone prior endoscopic and/or open transcranial approaches for resection of their pathologies. Additionally, 3/13 patients underwent radiation or chemotherapy radiation prior to the combined approach.</p><p><strong>Results: </strong>The desired clinical outcome (i.e., gross total tumor resection, resolution of infection, and skull base resection/repair) was achieved in 12/13 cases. One case had subtotal resection (Simpson grade III) of an olfactory groove meningioma. Postoperatively, there was one 30-day mortality due to pulmonary infarction, one case with hydrocephalus requiring ventriculoperitoneal shunt placement, and one flap infection due to postoperative cocaine use resulting in revisions and hospice. Importantly, no patients experienced postoperative CSF leaks, including those who underwent postoperative chemotherapy/radiation.</p><p><strong>Conclusion: </strong>This case series suggests that a concurrent combined endoscopic transcranial approach, in carefully selected patients, can treat a wide range of complex and recurrent skull base pathologies resistant to previous treatment, with a reasonable rate of postoperative wound/leak complications.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"107-115"},"PeriodicalIF":0.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling an Untold Legacy: The History of the North American Skull Base Society from the Recollections of Early Presidents.","authors":"Karenna J Groff, Aneek Patel, Carter M Suryadevara, David B Kurland, Akshay Save, Donato Pacione, John G Golfinos, Carl H Snyderman, Chandranath Sen","doi":"10.1055/a-2509-0223","DOIUrl":"10.1055/a-2509-0223","url":null,"abstract":"<p><strong>Introduction: </strong>Skull base surgery is a highly innovative, multidisciplinary field that brings together teams of neurosurgeons, otolaryngology-head and neck surgeons (OHNS), plastic surgeons, ophthalmologists, radiation oncologists, and others. However, not long ago, the nascent field was instead characterized by isolated individual brilliance.</p><p><strong>Methods: </strong>This paper explores the contributions of several key players toward breaking silos and transforming the field into what it is today. Our analysis centers on the formation of the North American Skull Base Society (NASBS), and the instrumental role that it played in the development of skull base surgery. We interviewed 12 past presidents of the NASBS and 2 prominent figures in skull base surgery. The contents of those 20 hours and 38 minutes of interviews and documents from initial NASBS meetings were analyzed. Key moments were segmented into short video clips, which complement this manuscript and are available on the NASBS website.</p><p><strong>Results: </strong>A compelling narrative of collaboration, mentorship, and tenacity emerged from our analysis. In the 20th century, the field of skull base surgery was characterized mainly by courageous but isolated efforts by neurosurgeons and OHNS surgeons. Through mentorship, collaboration, and incredible innovation, it has since grown into a multidisciplinary, cutting-edge specialty that utilizes the strengths of several medical specialties. This transformation was largely facilitated by the formation of the NASBS in 1989, which enabled worldwide communication and collaboration among those dedicated to advancing the field.</p><p><strong>Conclusion: </strong>The growth of skull base surgery in North America and the instrumental role of the NASBS highlight the power of collaboration and innovation. It is important to recognize and celebrate the key players who facilitated the creation and success of the NASBS, which continues to unite young members across countless disciplines under one banner.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"1-13"},"PeriodicalIF":0.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Alternative Flaps in Endoscopic Skull Base Repair: A Comparative Cadaveric Study between Inferior Turbinate and Nasoseptal Flaps.","authors":"Kue Tylor Lee, Kathryn Brieck, Victoria N Hunyh, Diana Bigler, Kareem Haroun, Camilo Reyes Gelves","doi":"10.1055/a-2510-4717","DOIUrl":"10.1055/a-2510-4717","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past several decades expanded endonasal approaches have advanced significantly, paralleling the increasing importance of skull base defect reconstruction. The nasoseptal flap (NSF) is first line for most skull base reconstruction but may fail for complex or recurrent cerebrospinal fluid (CSF) leaks in central skull base. The inferior turbinate flap (ITF) presents an alternative due to proximity and robust vascular supply. This cadaveric study compares the NSF and ITF in central skull base repairs, detailing indications, limitations, and dimensions.</p><p><strong>Methods: </strong>We analyzed five cadaveric head specimens provided by the Medical College of Georgia Department of Anatomy. The NSF and ITF were raised bilaterally on each head, yielding 20 flaps in total. Length and width of each flap were measured, and total coverage area was calculated. SPSS (ver.20.0) was used for statistical analysis. Differences in mean width, length, and coverage area between the NSF and ITF were analyzed using Student's two-independent sample <i>t</i> -test, with <i>p</i> -values <0.05 considered statistically significant.</p><p><strong>Results: </strong>The NSF was significantly longer (64.6 mm) than ITF (42.8 mm), but the ITF was wider (46.6 mm) than NSF (36.5 mm). NSF had a larger mean coverage area (23.6 cm ² ) than ITF (19.9 cm ² ) ( <i>p</i>  = 0.053).</p><p><strong>Conclusion: </strong>While the NSF provides superior coverage, the ITF is a viable option in the reconstruction ladder for central skull base defects when NSF fails, offering advantages in terms of proximity, vascular supply, and lower morbidity over other rescue flaps. Surgical technique in harvesting this flap should be known to any skull base surgeon over other more complex reconstruction flaps.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":"e31-e36"},"PeriodicalIF":0.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey of 251 Facial Paralysis Patients to Assess Their Educational Preparedness and Symptom Management after Treatment of Vestibular Schwannoma.","authors":"Garni Barkhoudarian, Walavan Sivakumar, Courtney J Voelker, Shanthi Gowrinathan, Akanksha Sharma, Hsin-Fang Li, Amit Kochhar","doi":"10.1055/a-2446-9674","DOIUrl":"10.1055/a-2446-9674","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate how patients with vestibular schwannoma (VS) were prepared for facial paralysis (FP).</p><p><strong>Study design: </strong>This study comprised an online survey of members of the Acoustic Neuroma Association of America who had FP.</p><p><strong>Methods: </strong>A 28-question survey gathering information on the patient experience related to management of FP was created. Associations between treatment setting and presence of FP were analyzed using SAS Enterprise Guide 8.4. Significance was considered at <i>p</i> -values < 0.05 in a univariate and multivariable model.</p><p><strong>Results: </strong>A total of 251 subjects with VS and FP responded. A total of 14% presented with FP, 70% were diagnosed with VS at least 6 months prior to treatment, and 61% were treated at academic centers. A total of 28% felt prepared for life with FP and 42% were confident their medical team understood management. Less than 30% of respondents received educational materials. After developing FP, speech and swallow difficulty and anxiety were common, but few respondents were referred for expert management. Subjects at academic centers were more often referred to specialists in the same location. Those with preoperative FP felt their medical teams better prepared them for it, had fewer complaints of difficulty speaking, and were happier with their recovery.</p><p><strong>Conclusion: </strong>Significant gaps in preparation and management of FP were identified. Preoperative FP led to improved perception of care; however, the delivery was similar to those without it. Studies of surgeons who manage VS are needed to better understand how they prepare patients for the emotional and physical sequelae of FP.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"86 6","pages":"626-639"},"PeriodicalIF":0.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12552053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Venous Stenting on Symptoms and Quality of Life in Patients with Idiopathic Intracranial Hypertension and Spontaneous Cerebrospinal Fluid Leak.","authors":"Shreya Mandloi, Areeba Nisar, Samuel R Shing, Chase Kahn, Peter A Benedict, Alexander Duffy, Kareem E Naamani, David Bray, M Reid Gooch, Elina Toskala, James Evans, Christopher Farrell, Marc Rosen, Mindy R Rabinowitz, Hsiangkuo Yuan, Gurston G Nyquist","doi":"10.1055/a-2461-5445","DOIUrl":"10.1055/a-2461-5445","url":null,"abstract":"<p><strong>Background: </strong>Elevated intracranial pressure can cause skull base defects and a spontaneous cerebrospinal fluid (CSF) leak. Venous sinus stenting (VSS) has emerged as a promising treatment option for patients with a CSF leak in the setting of idiopathic intracranial hypertension (IIH). There is a lack of literature on symptomatology and quality of life (QOL) after VSS for IIH patients with a CSF leak. This study explores the effects of VSS on symptoms and QOL in IIH patients with a CSF leak.</p><p><strong>Methods: </strong>This is a retrospective study on patients who have IIH complicated by a CSF leak and underwent VSS. A QOL questionnaire was developed from the migraine disability assessment test and the PROMIS-PI was given to patients included in this study.</p><p><strong>Results: </strong>A total of 10 patients were included in this study. Nine patients underwent endoscopic closure of CSF prior to stent placement and one patient was treated with VSS only. There was no evidence of CSF leak recurrence in this population following VSS. Headaches improved in 5/8, tinnitus in 5/6, and visual disturbance in 4/5 patients. Diamox was discontinued in seven out of eight patients after VSS. There was an improvement in headache-specific questions ( <i>p</i>  = 0.0140) and overall QOL ( <i>p</i>  = 0.0061) on the QOL questionnaire.</p><p><strong>Discussion: </strong>This preliminary study demonstrates that VSS is effective in alleviating many symptoms in IIH patients with a CSF leak, especially headaches. Diamox may be able to be discontinued in many patients following VSS. No CSF leak recurrence was noted in this patient population.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"86 6","pages":"661-666"},"PeriodicalIF":0.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12552043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Anatomy of the Retrosigmoid Approach with Endoscopic-Assisted Reverse Anterior Petrosectomy: Optimizing Meckel's Cave Access from the Posterior Fossa.","authors":"Alessandro De Bonis, Fabio Torregrossa, Danielle D Dang, Luciano César P C Leonel, Pietro Mortini, Michael Link, Driscoll Colin, Maria Peris-Celda","doi":"10.1055/a-2461-5608","DOIUrl":"10.1055/a-2461-5608","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated the extent of access to Meckel's cave (MC) and the middle cranial fossa (MCF) protecting the internal carotid artery (ICA) using the retrosigmoid approach with endoscopic-assisted reverse anterior petrosectomy (EA-RAP).</p><p><strong>Methods: </strong>Five specimens were dissected using the limited and extended EA-RAP. Based on the bone removal of the internal acoustic meatus (IAM) and subarcuate fossa, exposure of the MC and ICA were statistically compared.</p><p><strong>Results: </strong>The limited and extended EA-RAP allowed access to the medial and anterior MC (4 mm posterior to the first genu of the cavernous ICA, and 20 mm posterior to foramen rotundum [FR]). The access to the lateral MC varied with distance of 12 and 8 mm medial to the foramen ovale for the limited and extended EA-RAP, respectively.In the extended EA-RAP, the exposure of the ICA was gained by drilling with the 0-degree endoscope (3 mm) versus 45-degree endoscope (9 mm). The working distances from the midpoint of the IAM to the most medial point of the exposed ICA was 24 mm. The most lateral point of the exposed ICA varied between 0- and 45-degree endoscopes with a distance of 21 and 13 mm, respectively.</p><p><strong>Conclusion: </strong>A coronal plane from the posterior genu of the cavernous ICA and a sagittal plane to the common crus of the semicircular canals can define the area of MCF accessed by the EA-RAP. Drilling of the temporal bone should be carefully customized according to the patient and can be aided by endoscopic assistance for direct visualization to minimize the risk of injuries to ICA.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"86 6","pages":"640-651"},"PeriodicalIF":0.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12552045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}