Article

[Temporopolar epidural transcavernous transpetrous approach. Technique and indications].

Service de neurochirurgie, CHU, hôpital Sainte-Marguerite, APHM, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille cedex 09, France.
Neurochirurgie (Impact Factor: 0.32). 03/2007; 53(1):23-31. DOI: 10.1016/j.neuchi.2006.10.002
Source: PubMed

ABSTRACT Several selective approaches have been recommended for access to the petroclival region (PCR). However, locoregional extension of the tumor may necessitate more extensive procedures. Dissections from injected specimens allowed us to describe the different osteodural triangles that are exposed to provide an extensive access to the PCR.
The bony step included a temporopterional flap and exposure of the paraclinoid carotid after removal of the anterior clinoid process. The sphenoid wing was then extensively drilled, exposing the foramen rotundum and ovale. An anterior petrosectomy was subsequently performed. The dura propria of the cavernous sinus was elevated as far as the Meckel cave. The sylvian fissure was also opened. Then, the temporobasal dura and the dura from the posterior surface of the petrous bone were opened and the superior petrosal sinus was coagulated and divided. The tentorium was divided toward its free edge.
Via this approach, cranial nerves from the olfactory tract to the acousticofacial bundle are exposed. In the same way, the ventral and lateral surface of the pons is identified.
The epidural temporopolar transcavernous transpetrous approach is useful to expose during the same procedure, elements of the posterior and middle cranial fossa. It is of particular value when managing tumors simultaneously involving the PCR, the parasellar, and the suprasellar regions.

1 Bookmark
 · 
71 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tumors within Meckel's cave are challenging and often require complex approaches. In this report, an expanded endoscopic endonasal approach is reported as a substitute for or complement to other surgical options for the treatment of various tumors within this region. A database of more than 900 patients who underwent the expanded endoscopic endonasal approach at the University of Pittsburgh Medical Center from 1998 to March of 2008 were reviewed. From these, only patients who had an endoscopic endonasal approach to Meckel's cave were considered. The technique uses the maxillary sinus and the pterygopalatine fossa as part of the working corridor. Infraorbital/V2 and the vidian neurovascular bundles are used as surgical landmarks. The quadrangular space is opened, which is bound by the internal carotid artery medially and inferiorly, V2 laterally, and the abducens nerve superiorly. This offers direct access to the anteroinferomedial segment of Meckel's cave, which can be extended through the petrous bone to reach the cerebellopontine angle. Forty patients underwent an endoscopic endonasal approach to Meckel's cave. The most frequent abnormalities encountered were adenoid cystic carcinoma, meningioma, and schwannomas. Meckel's cave and surrounding structures were accessed adequately in all patients. Five patients developed a new facial numbness in at least 1 segment of the trigeminal nerve, but the deficit was permanent in only 2. Two patients had a transient VIth cranial nerve palsy. Nine patients (30%) showed improvement of preoperative deficits on Cranial Nerves III to VI. In selected patients, the expanded endoscopic endonasal approach to the quadrangular space provides adequate exposure of Meckel's cave and its vicinity, with low morbidity.
    Neurosurgery 04/2009; 64(3 Suppl):ons71-82; discussion ons82-3. · 2.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A nonchordomatous solitary lesion of the clival bone is an exceptionally rare pathological entity, which represents a diagnostic and a therapeutic challenge. Many diseases with extremely different biological behavior, and requiring a dedicated treatment strategy, may result in similar clinical patterns. The approach to a correct differential diagnosis has to consider the specific epidemiological, radiological, and histopathological characteristics of each pathology to minimize the diagnostic bias and to allow the planning of the best treatment strategy. Because of the rarity of these diseases, a systematical review of nonchordomatous lesions of the clival bone still lack in the literature. The purposes of this study are to provide an overview of the epidemiological, clinical, radiological, and histopathological characteristics of nonchordomatous clival lesions, with particular emphasis on diagnostic and therapeutic strategies and related clinical outcome.
    Neurosurgical Review 04/2013; · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Comparative anatomical studies have proved to be invaluable in the evaluation of advantages and drawbacks of single approaches to access established target areas. Approach-related exposed areas do not necessarily represent useful areas when performing surgical manoeuvres. Accordingly the concept of “operability” has recently been introduced as a qualitative assessment of the ability to execute surgical manoeuvres. The authors propose an innovative model for the quantitative assessment of the operability, defined as “operability score” (OS), which can be effectively and easily applied to comparative studies on surgical anatomy. Methods A microanatomical study was conducted on six cadaveric heads. Results Morphometric measurements were collected and operability scores in selected target points of the surgical field were calculated. As illustrative example, the operability score was applied to the extradural subtemporal transzygomatic approach (ESTZ). Conclusion The operability score is effective in grading system of surgical operability, and instruments manipulation capability. It is a useful tool to evaluate, in a single approach, areas that can be exposed, and to quantify how those areas are suitable for surgical manoeuvres.
    Journal of Cranio-Maxillofacial Surgery 01/2014; · 1.61 Impact Factor