Quantitative Comparison of Retrosigmoid Intradural Suprameatal Approach and Retrosigmoid Transtentorial Approach: Implications for Tumors in the Petroclival Region

Sudheer Ambekar; Chiazo Amene; Ashish Sonig; Bharat Guthikonda; Anil Nanda

doi:10.1055/s-0033-1348025

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2013; 74(05): 300-304
DOI: 10.1055/s-0033-1348025

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Quantitative Comparison of Retrosigmoid Intradural Suprameatal Approach and Retrosigmoid Transtentorial Approach: Implications for Tumors in the Petroclival Region

Sudheer Ambekar

¹Department of Neurosurgery, LSUHSC-S, Shreveport, Louisiana, USA

,

Chiazo Amene

²Department of Neurosurgery, LSUHSC-Shreveport, Shreveport, Louisiana, USA

,

Ashish Sonig

³Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA

,

Bharat Guthikonda

¹Department of Neurosurgery, LSUHSC-S, Shreveport, Louisiana, USA

,

Anil Nanda

³Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA

› Author Affiliations

Abstract

Background Retrosigmoid transtentorial (RTT) and retrosigmoid intradural suprameatal (RISA) approaches have been used in the treatment of petroclival tumors.

Objective To compare the area of exposure of brainstem and petroclival region obtained through RTT and RISA in cadaveric specimens.

Methods Five cadaveric specimens with a total of 10 sides were analyzed. RTT and RISA were performed on five sides each. Brainstem and petroclival surface exposure were measured using both the approaches. These values were compared between the two approaches.

Results Brainstem area exposure with RTT was 441 ± 63 mm² and that with RISA was 311 ± 61 mm². Student's t-test revealed that the difference was significant (p = 0.01). The area of petroclival exposure medial to the Meckel cave through RTT was 696 ± 57 mm², and that through RISA was 716 ± 51 mm² (p = 0.69). The area of brainstem exposure between V and VII–VII complex through RTT and RISA was 387 ± 86 mm² and 378 ± 76 mm² (p = 0.87).

Conclusion The RTT approach is an excellent approach to ventrolateral brainstem and petroclival region. It provides greater superoventral exposure of the ventrolateral brainstem than RISA and provides similar petroclival exposure.

Keywords

petroclival meningioma - retrosigmoid - suprameatal - transtentorial

Full Text

References

References
1 Samii M, Ammirati M. The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir (Wien) 1988; 95 (1-2) 6-12
2 Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 1992; 76 (4) 588-599
3 Chanda A, Nanda A. Retrosigmoid intradural suprameatal approach: advantages and disadvantages from an anatomical perspective. Neurosurgery 2006; 59 (1) (Suppl. 01) ONS1-ONS6 , discussion ONS1–ONS6
4 House WF, De la Cruz A, Hitselberger WE. Surgery of the skull base: transcochlear approach to the petrous apex and clivus. Otolaryngology 1978; 86 (5) ORL-770-ORL-779
5 Hsu FP, Anderson GJ, Dogan A , et al. Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy. J Neurosurg 2004; 100 (4) 695-699
6 Kanzaki J, Kawase T, Sano K, Shiobara R, Toya S. A modified extended middle cranial fossa approach for acoustic tumors. Arch Otorhinolaryngol 1977; 217 (1) 119-121
7 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (6) 857-861
8 Malis LI. The petrosal approach. Clin Neurosurg 1991; 37: 528-540
9 Quiñones-Hinojosa A, Chang EF, Lawton MT. The extended retrosigmoid approach: an alternative to radical cranial base approaches for posterior fossa lesions. Neurosurgery 2006; 58 (4) (Suppl. 02) ONS-208-ONS-214 , discussion ONS-214
10 Koerbel A, Kirschniak A, Ebner FH, Tatagiba M, Gharabaghi A. The retrosigmoid intradural suprameatal approach to posterior cavernous sinus: microsurgical anatomy. Eur J Surg Oncol 2009; 35 (4) 368-372
11 Mathiesen T, Gerlich A, Kihlström L, Svensson M, Bagger-Sjöbäck D. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 2007; 60 (6) 982-991 , discussion 991–992
12 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (5) 1268-1277
13 Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007; 60 (6) 965-979 , discussion 979–981
14 Samii M, Tatagiba M, Carvalho GA. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome. J Neurosurg 2000; 92 (2) 235-241
15 Kawamata T, Katayama Y. [Lateral supracerebellar transtentorial approach for petroclival lesions]. No Shinkei Geka 2006; 34 (6) 567-575
16 Seoane E, Rhoton Jr AL. Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery 1999; 44 (3) 553-560
17 Campbell E, Whitfield RD. Posterior fossa meningiomas. J Neurosurg 1948; 5 (2) 131-153
18 Russell JR, Bucy PC. Meningiomas of the posterior fossa. Surg Gynecol Obstet 1953; 96 (2) 183-192
19 Park CK, Jung HW, Kim JE, Paek SH, Kim DG. The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol 2006; 66 (2) 160-165 , discussion 165–166
20 Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J. Petroclival meningiomas: is radical resection always the best option?. J Neurol Neurosurg Psychiatry 1997; 62 (4) 341-345
21 Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007; 60 (6) 965-979 , discussion 979–981
22 Watanabe T, Katayama Y, Fukushima T, Kawamata T. Lateral supracerebellar transtentorial approach for petroclival meningiomas: operative technique and outcome. J Neurosurg 2011; 115 (1) 49-54