Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions

Journal of Neurosurgery
Hans-Jakob SteigerPeter A Winkler

Abstract

The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50-100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Ka...Continue Reading

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Citations

Mar 23, 2010·Journal of Neurosurgery·Erik Friedrich HauckDuke Samson
Aug 3, 2012·Neurosurgical Focus·Bradley A GrossOssama Al-Mefty
Aug 3, 2012·Neurosurgical Focus·Bradley A GrossIan F Dunn
May 5, 2012·Current Treatment Options in Cardiovascular Medicine·Tarek Y El AhmadiehH Hunt Batjer
Nov 11, 2010·Rinshō shinkeigaku = Clinical neurology·Takahiro YamamotoMakoto Uchino
May 4, 2010·Acta neurochirurgica·Patrick FrançoisStephane Velut
Oct 27, 2011·Neurologia Medico-chirurgica·Takahiro MurataKazuhiro Hongo
Nov 13, 2013·Seminars in Ultrasound, CT, and MR·Mohamad R ChaabanKristen Owen Riley
Apr 10, 2012·World Neurosurgery·Bradley A GrossRose Du
Nov 29, 2011·World Neurosurgery·Thomas WestermaierRalf-Ingo Ernestus
Sep 8, 2010·Neurologic Clinics·Edward A M Duckworth
Apr 5, 2016·Neurosurgical Review·Shinya IchimuraPeter Vajkoczy
Dec 4, 2008·Neurosurgery·Erik F HauckDuke Samson
May 1, 2009·Neurosurgery·Bradley A GrossBernard R Bendok
May 20, 2015·Surgical Neurology International·Nikhil R NayakJohn Y K Lee
May 7, 2009·Neurosurgery·Pakrit JittapiromsakMark C Preul
May 11, 2012·Neurosurgery·Matthew R SanbornJohn Y K Lee

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