Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure
IntroductionWhile accessing the posterior fossa, the anterior transpetrosal approach (ATPA) and endoscopic transorbital approach (ETOA) use the same bony landmarks during petrous apex drilling. However, owing to their contrasting surgical axes, they are expected to show differences in surgical view,...
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1186012/full |
| _version_ | 1797785603247439872 |
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| author | Sae Min Kwon Min Kyun Na Kyu-Sun Choi Hyoung Soo Byoun Yong Seok Nam |
| author_facet | Sae Min Kwon Min Kyun Na Kyu-Sun Choi Hyoung Soo Byoun Yong Seok Nam |
| author_sort | Sae Min Kwon |
| collection | DOAJ |
| description | IntroductionWhile accessing the posterior fossa, the anterior transpetrosal approach (ATPA) and endoscopic transorbital approach (ETOA) use the same bony landmarks during petrous apex drilling. However, owing to their contrasting surgical axes, they are expected to show differences in surgical view, maneuverability, and clinical implications. This study aimed to investigate the feasibility of ETOA in accessing the brainstem and to compare the surgical view and maneuverability of each approach.MethodsATPA and ETOA were performed in four human cadaveric heads (eight sides and four sides in each procedure). The angle of attack (AOA) and surgical depth were measured at the target of interest (root exit zone [REZ] of cranial nerve [CN] V, VI, and VII). When measuring the area of exposure, the brainstem was divided into two areas (anterior and lateral brainstem) based on the longitudinal line crossing the entry zone of the trigeminal root, and the area of each was measured.ResultsATPA showed significantly greater value at the trigeminal REZ in both vertical (31.8 ± 6.7° vs. 14.3 ± 5.3°, p=0.006) and horizontal AOA (48.5 ± 2.9° vs. 15.0 ± 5.2°, p<0.001) than ETOA. The AOA at facial REZ was also greater in ATPA than ETOA (vertical, 27.5 ± 3.9° vs. 8.3 ± 3.3°, p<0.001; horizontal, 33.8 ± 2.2° vs. 11.8 ± 2.9°, p<0.001). ATPA presented significantly shorter surgical depth (CN V, 5.8 ± 0.5 cm vs. 9.0 ± 0.8, p<0.001; CN VII, 6.3 ± 0.5 cm vs. 9.5 ± 1.0, p=0.001) than ETOA. The mean area of brainstem exposure did not differ between the two approaches. However, ATPA showed significantly better exposure of anterior brainstem than ETOA (240.7 ± 9.6 mm2 vs. 171.7 ± 15.0 mm2, p<0.001), while ETOA demonstrated better lateral brainstem exposure (174.2 ± 29.1 mm2 vs. 231.1 ± 13.6 mm2, p=0.022).ConclusionsETOA could be a valid surgical option, in selected cases, that provides a direct ventral route to the brainstem. Compared with ATPA, ETOA showed less surgical maneuverability, AOA and longer surgical depth; however, it presented comparable brainstem exposure and better exposure of the lateral brainstem. |
| first_indexed | 2024-03-13T00:56:23Z |
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| id | doaj.art-bc434428cd7e48139d8b2db31bceae9b |
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| language | English |
| last_indexed | 2024-03-13T00:56:23Z |
| publishDate | 2023-07-01 |
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| spelling | doaj.art-bc434428cd7e48139d8b2db31bceae9b2023-07-06T19:12:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-07-011310.3389/fonc.2023.11860121186012Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposureSae Min Kwon0Min Kyun Na1Kyu-Sun Choi2Hyoung Soo Byoun3Yong Seok Nam4Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of KoreaDepartment of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of KoreaDepartment of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of KoreaDepartment of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Republic of KoreaDepartment of Anatomy, College of Korean Medicine, Dongshin University, Naju, Republic of KoreaIntroductionWhile accessing the posterior fossa, the anterior transpetrosal approach (ATPA) and endoscopic transorbital approach (ETOA) use the same bony landmarks during petrous apex drilling. However, owing to their contrasting surgical axes, they are expected to show differences in surgical view, maneuverability, and clinical implications. This study aimed to investigate the feasibility of ETOA in accessing the brainstem and to compare the surgical view and maneuverability of each approach.MethodsATPA and ETOA were performed in four human cadaveric heads (eight sides and four sides in each procedure). The angle of attack (AOA) and surgical depth were measured at the target of interest (root exit zone [REZ] of cranial nerve [CN] V, VI, and VII). When measuring the area of exposure, the brainstem was divided into two areas (anterior and lateral brainstem) based on the longitudinal line crossing the entry zone of the trigeminal root, and the area of each was measured.ResultsATPA showed significantly greater value at the trigeminal REZ in both vertical (31.8 ± 6.7° vs. 14.3 ± 5.3°, p=0.006) and horizontal AOA (48.5 ± 2.9° vs. 15.0 ± 5.2°, p<0.001) than ETOA. The AOA at facial REZ was also greater in ATPA than ETOA (vertical, 27.5 ± 3.9° vs. 8.3 ± 3.3°, p<0.001; horizontal, 33.8 ± 2.2° vs. 11.8 ± 2.9°, p<0.001). ATPA presented significantly shorter surgical depth (CN V, 5.8 ± 0.5 cm vs. 9.0 ± 0.8, p<0.001; CN VII, 6.3 ± 0.5 cm vs. 9.5 ± 1.0, p=0.001) than ETOA. The mean area of brainstem exposure did not differ between the two approaches. However, ATPA showed significantly better exposure of anterior brainstem than ETOA (240.7 ± 9.6 mm2 vs. 171.7 ± 15.0 mm2, p<0.001), while ETOA demonstrated better lateral brainstem exposure (174.2 ± 29.1 mm2 vs. 231.1 ± 13.6 mm2, p=0.022).ConclusionsETOA could be a valid surgical option, in selected cases, that provides a direct ventral route to the brainstem. Compared with ATPA, ETOA showed less surgical maneuverability, AOA and longer surgical depth; however, it presented comparable brainstem exposure and better exposure of the lateral brainstem.https://www.frontiersin.org/articles/10.3389/fonc.2023.1186012/fulltransorbital approachendoscopebrainstemanterior petrosectomyskull base |
| spellingShingle | Sae Min Kwon Min Kyun Na Kyu-Sun Choi Hyoung Soo Byoun Yong Seok Nam Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure Frontiers in Oncology transorbital approach endoscope brainstem anterior petrosectomy skull base |
| title | Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure |
| title_full | Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure |
| title_fullStr | Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure |
| title_full_unstemmed | Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure |
| title_short | Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure |
| title_sort | cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy comparison of surgical maneuverability and brainstem exposure |
| topic | transorbital approach endoscope brainstem anterior petrosectomy skull base |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1186012/full |
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