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DOI: 10.1055/s-0041-1741067
Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers
Funding This study was supported by funds from the Newsome Chair in Neurosurgery Research held by M.C.P. at Barrow Neurological Institute and from the Barrow Neurological Foundation.
Abstract
Objectives Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies.
Design This study presents anatomical dissection and quantitative analysis.
Setting Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques.
Participants Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides.
Main Outcomes and Measures Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume.
Results The IMP technique provided a greater area of exposure (p < 0.01) and bone resection volume (p < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique (p < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [p = 0.04], anterior inferior cerebellar artery [p < 0.01], proximal part of the cisternal CN VI segment [p = 0.02]) and IP (flocculus [p = 0.02] and the proximal [p = 0.02] and distal parts [p = 0.02] of the CN VII/VIII complex) techniques.
Conclusion Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques.
Note
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript. E.B. is currently at the Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States.
Publikationsverlauf
Eingereicht: 19. Januar 2021
Angenommen: 12. November 2021
Artikel online veröffentlicht:
14. Januar 2022
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