Irakliy Abramov, Mohamed A Labib, Lena Mary Houlihan, Thanapong Loymak, Visish M Srinivasan, Mark C Preul, Michael T Lawton
{"title":"经齿状突极外侧入路与经鼻内窥镜极内侧入路颈静脉孔及颅椎交界处的定量解剖比较。","authors":"Irakliy Abramov, Mohamed A Labib, Lena Mary Houlihan, Thanapong Loymak, Visish M Srinivasan, Mark C Preul, Michael T Lawton","doi":"10.1227/ons.0000000000000350","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions to resect.</p><p><strong>Objective: </strong>To compare the extreme lateral transodontoid approach (ELTOA) with the extreme medial endoscopic endonasal approach (EMEEA) to determine the most effective surgical approach to the JF and CVJ.</p><p><strong>Methods: </strong>Seven formalin-fixed cadaveric heads were dissected. Using neuronavigation, we quantitatively measured and compared the exposure of the intracranial and extracranial neurovascular structures, the drilled area of the clivus and the C1 vertebra, and the area of exposure of the brainstem.</p><p><strong>Results: </strong>The mean total drilled area of the clivus was greater with the EMEEA than with the ELTOA (1043.5 vs 909.4 mm 2 , P = .02). The EMEEA provided a longer exposure of the extracranial cranial nerves (CNs) IX, X, and XI compared with the ELTOA (cranial nerve [CN] IX: 18.8 vs 12.0 mm, P = .01; CN X: 19.2 vs 10.4 mm, P = .003; and CN XI, 18.1 vs 11.9 mm, P = .04). The EMEEA, compared with the ELTOA, provided a significantly greater area of exposure of the contralateral ventromedial medulla (289.5 vs 80.9 mm 2 , P < .001) and pons (237.5 vs 86.2 mm 2 , P = .005) but less area of exposure of the ipsilateral dorsolateral medulla (51.5 vs 205.8 mm 2 , P = .008).</p><p><strong>Conclusion: </strong>The EMEEA and ELTOA provide optimal exposures to different aspects of the CVJ and JF. A combination of these approaches can compensate for their disadvantages and achieve significant exposure.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"396-405"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Quantitative Anatomic Comparison of the Extreme Lateral Transodontoid vs Extreme Medial Endoscopic Endonasal Approaches to the Jugular Foramen and Craniovertebral Junction.\",\"authors\":\"Irakliy Abramov, Mohamed A Labib, Lena Mary Houlihan, Thanapong Loymak, Visish M Srinivasan, Mark C Preul, Michael T Lawton\",\"doi\":\"10.1227/ons.0000000000000350\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions to resect.</p><p><strong>Objective: </strong>To compare the extreme lateral transodontoid approach (ELTOA) with the extreme medial endoscopic endonasal approach (EMEEA) to determine the most effective surgical approach to the JF and CVJ.</p><p><strong>Methods: </strong>Seven formalin-fixed cadaveric heads were dissected. Using neuronavigation, we quantitatively measured and compared the exposure of the intracranial and extracranial neurovascular structures, the drilled area of the clivus and the C1 vertebra, and the area of exposure of the brainstem.</p><p><strong>Results: </strong>The mean total drilled area of the clivus was greater with the EMEEA than with the ELTOA (1043.5 vs 909.4 mm 2 , P = .02). The EMEEA provided a longer exposure of the extracranial cranial nerves (CNs) IX, X, and XI compared with the ELTOA (cranial nerve [CN] IX: 18.8 vs 12.0 mm, P = .01; CN X: 19.2 vs 10.4 mm, P = .003; and CN XI, 18.1 vs 11.9 mm, P = .04). The EMEEA, compared with the ELTOA, provided a significantly greater area of exposure of the contralateral ventromedial medulla (289.5 vs 80.9 mm 2 , P < .001) and pons (237.5 vs 86.2 mm 2 , P = .005) but less area of exposure of the ipsilateral dorsolateral medulla (51.5 vs 205.8 mm 2 , P = .008).</p><p><strong>Conclusion: </strong>The EMEEA and ELTOA provide optimal exposures to different aspects of the CVJ and JF. A combination of these approaches can compensate for their disadvantages and achieve significant exposure.</p>\",\"PeriodicalId\":520730,\"journal\":{\"name\":\"Operative neurosurgery (Hagerstown, Md.)\",\"volume\":\" \",\"pages\":\"396-405\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Operative neurosurgery (Hagerstown, Md.)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/ons.0000000000000350\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/8/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Operative neurosurgery (Hagerstown, Md.)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/ons.0000000000000350","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/8/29 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
摘要
背景:颈静脉孔(JF)和前颅椎交界处(CVJ)的大的、破坏性的颅内和颅外病变是最难切除的病变之一。目的:比较极外侧经齿状突入路(ELTOA)与极内侧内窥镜鼻内入路(EMEEA),以确定最有效的JF和CVJ手术入路。方法:解剖7具经福尔马林固定的尸体头部。利用神经导航技术,定量测量并比较了颅外神经血管结构的暴露、斜坡和C1椎的钻孔面积以及脑干的暴露面积。结果:EMEEA组斜坡的平均总钻孔面积大于ELTOA组(1043.5 vs 909.4 mm 2, P = 0.02)。CN X: 19.2 vs 10.4 mm, P = 0.003;与ELTOA相比,EMEEA提供了更大的对侧腹内侧髓质暴露面积(289.5 vs 80.9 mm 2, P <.001)和脑桥(237.5 vs 86.2 mm 2, P = 0.005),但同侧背外侧髓质暴露面积较小(51.5 vs 205.8 mm 2, P = 0.008)。结论:EMEEA和ELTOA提供了CVJ和JF不同方面的最佳暴露。这些方法的组合可以弥补它们的缺点并获得显著的曝光。
Quantitative Anatomic Comparison of the Extreme Lateral Transodontoid vs Extreme Medial Endoscopic Endonasal Approaches to the Jugular Foramen and Craniovertebral Junction.
Background: Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions to resect.
Objective: To compare the extreme lateral transodontoid approach (ELTOA) with the extreme medial endoscopic endonasal approach (EMEEA) to determine the most effective surgical approach to the JF and CVJ.
Methods: Seven formalin-fixed cadaveric heads were dissected. Using neuronavigation, we quantitatively measured and compared the exposure of the intracranial and extracranial neurovascular structures, the drilled area of the clivus and the C1 vertebra, and the area of exposure of the brainstem.
Results: The mean total drilled area of the clivus was greater with the EMEEA than with the ELTOA (1043.5 vs 909.4 mm 2 , P = .02). The EMEEA provided a longer exposure of the extracranial cranial nerves (CNs) IX, X, and XI compared with the ELTOA (cranial nerve [CN] IX: 18.8 vs 12.0 mm, P = .01; CN X: 19.2 vs 10.4 mm, P = .003; and CN XI, 18.1 vs 11.9 mm, P = .04). The EMEEA, compared with the ELTOA, provided a significantly greater area of exposure of the contralateral ventromedial medulla (289.5 vs 80.9 mm 2 , P < .001) and pons (237.5 vs 86.2 mm 2 , P = .005) but less area of exposure of the ipsilateral dorsolateral medulla (51.5 vs 205.8 mm 2 , P = .008).
Conclusion: The EMEEA and ELTOA provide optimal exposures to different aspects of the CVJ and JF. A combination of these approaches can compensate for their disadvantages and achieve significant exposure.