Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy
Introduction: The petroclival region is among the most challenging anatomical areas to deal with in skull base surgery. Drilling of the anterior part of the petrous bone during the anterior transpetrosal approach involves the risk of injury of the cochlea, superior semicircular canal, internal carot...
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MDPI AG
2021-04-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/11/4/488 |
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| author | Ana Flores-Justa Sabino Luzzi Alice Giotta Lucifero Juan F. Villalonga Amparo Saenz José María Santin-Amo Matias Baldoncini Alvaro Campero |
| author_facet | Ana Flores-Justa Sabino Luzzi Alice Giotta Lucifero Juan F. Villalonga Amparo Saenz José María Santin-Amo Matias Baldoncini Alvaro Campero |
| author_sort | Ana Flores-Justa |
| collection | DOAJ |
| description | Introduction: The petroclival region is among the most challenging anatomical areas to deal with in skull base surgery. Drilling of the anterior part of the petrous bone during the anterior transpetrosal approach involves the risk of injury of the cochlea, superior semicircular canal, internal carotid artery, and internal auditory canal. A thorough understanding of the microneurosurgical anatomy of this region is mandatory to execute the transpetrosal approaches, decreasing the risk of complications. The aim of this study is to describe the anatomical structures of the petroclival region, highlighting the importance of neuronavigation for safe performance of the anterior transpetrosal approach. Methods: Three adult cadaveric human heads were formalin-fixed and injected with colored silicone. They underwent an axial 1 mm slab CT scan, which was used for neuronavigation during the surgical approaches. The anterior petrosectomy was performed with the aid of neuronavigation during the drilling of the petrous bone. The surgical management of a patient harboring a petroclival meningioma, operated on using an anterior transpetrosal approach, was reported as an illustrative case. Results: The anterior petrosectomy was completed accurately with wide exposure of the surgical target without injuring the cochlea and other structures in all three cadaveric specimens. In the surgical case, no approach-related complications occurred, and a gross total resection of the tumor was achieved. Conclusions: Deep knowledge of the location and relationships of the vital elements located within the temporal bone, along with the use of neuronavigation, are the key aspects to perform the anterior transpetrosal approach safely, reducing the risk of complications. |
| first_indexed | 2024-03-10T12:24:02Z |
| format | Article |
| id | doaj.art-595f36bfb0494ecabb4771adbe951d34 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T12:24:02Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-595f36bfb0494ecabb4771adbe951d342023-11-21T15:13:21ZengMDPI AGBrain Sciences2076-34252021-04-0111448810.3390/brainsci11040488Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior PetrosectomyAna Flores-Justa0Sabino Luzzi1Alice Giotta Lucifero2Juan F. Villalonga3Amparo Saenz4José María Santin-Amo5Matias Baldoncini6Alvaro Campero7Department of Neurosurgery, Hospital General of Alicante, 3010 Alicante, SpainNeurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyNeurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyLINT, Facultad de Medicina, Universidad Nacional de Tucumán, T4000 Tucumán, ArgentinaLINT, Facultad de Medicina, Universidad Nacional de Tucumán, T4000 Tucumán, ArgentinaDepartment of Neurological Surgery, Hospital Xeral-Calde, 27004 Lugo, SpainLaboratory of Neuroanatomic Microsurgical—LaNeMic-II Division of Anatomy, School of Medicine, University of Buenos Aires, C1053 CABA Buenos Aires, ArgentinaLINT, Facultad de Medicina, Universidad Nacional de Tucumán, T4000 Tucumán, ArgentinaIntroduction: The petroclival region is among the most challenging anatomical areas to deal with in skull base surgery. Drilling of the anterior part of the petrous bone during the anterior transpetrosal approach involves the risk of injury of the cochlea, superior semicircular canal, internal carotid artery, and internal auditory canal. A thorough understanding of the microneurosurgical anatomy of this region is mandatory to execute the transpetrosal approaches, decreasing the risk of complications. The aim of this study is to describe the anatomical structures of the petroclival region, highlighting the importance of neuronavigation for safe performance of the anterior transpetrosal approach. Methods: Three adult cadaveric human heads were formalin-fixed and injected with colored silicone. They underwent an axial 1 mm slab CT scan, which was used for neuronavigation during the surgical approaches. The anterior petrosectomy was performed with the aid of neuronavigation during the drilling of the petrous bone. The surgical management of a patient harboring a petroclival meningioma, operated on using an anterior transpetrosal approach, was reported as an illustrative case. Results: The anterior petrosectomy was completed accurately with wide exposure of the surgical target without injuring the cochlea and other structures in all three cadaveric specimens. In the surgical case, no approach-related complications occurred, and a gross total resection of the tumor was achieved. Conclusions: Deep knowledge of the location and relationships of the vital elements located within the temporal bone, along with the use of neuronavigation, are the key aspects to perform the anterior transpetrosal approach safely, reducing the risk of complications.https://www.mdpi.com/2076-3425/11/4/488Kawase approachpetroclival areapetrous boneskull basetranspetrosal approach |
| spellingShingle | Ana Flores-Justa Sabino Luzzi Alice Giotta Lucifero Juan F. Villalonga Amparo Saenz José María Santin-Amo Matias Baldoncini Alvaro Campero Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy Brain Sciences Kawase approach petroclival area petrous bone skull base transpetrosal approach |
| title | Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy |
| title_full | Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy |
| title_fullStr | Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy |
| title_full_unstemmed | Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy |
| title_short | Use of Neuroanatomic Knowledge and Neuronavigation System for a Safe Anterior Petrosectomy |
| title_sort | use of neuroanatomic knowledge and neuronavigation system for a safe anterior petrosectomy |
| topic | Kawase approach petroclival area petrous bone skull base transpetrosal approach |
| url | https://www.mdpi.com/2076-3425/11/4/488 |
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