Subscribe to RSS
DOI: 10.1055/s-0029-1220199
© Thieme Medical Publishers
Microsurgical and Endoscopic Anatomy of the Retrosigmoid Intradural Suprameatal Approach to Lesions Extending from the Posterior Fossa to the Central Skull Base
Publication History
Publication Date:
09 April 2009 (online)
![](https://www.thieme-connect.de/media/sbs/200905/lookinside/thumbnails/10.1055-s-0029-1220199-1.jpg)
ABSTRACT
This article evaluates the accessibility of the posterior part of the central skull base via the extended retrosigmoid intradural suprameatal approach. In formaldehyde-fixed specimens, the retrosigmoid intradural suprameatal approach was performed, and the feasibility of reaching central skull base structures was analyzed. Microscopic and endoscopic techniques were used. The main outcome measures were digital films and screenshots, which were analyzed regarding quantitative and qualitative aspects of visual structures. By drilling off the suprameatal tubercle and part of the petrous apex, Meckel's cave may be opened, the trigeminal nerve mobilized, and the tentorium divided. Thus the parasellar area may be exposed and the posterosuperior space of the cavernous sinus approached. Using an endoscope-assisted technique and following cisternal anatomy, the sellar and parasellar region may be explored even if the working space is narrow. The retrosigmoid intradural suprameatal approach provides optimal accessibility to medially located central skull base structures, in particular to the posterior part of the cavernous sinus. Use of the endoscope may remarkably optimize the accessibility.
KEYWORDS
Central skull base - retrosigmoid suprameatal approach - cavernous sinus - endoscopy
REFERENCES
- 1 Samii M, Tatagiba M, Carvalho G A. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome. J Neurosurg. 2000; 92 235-241
- 2 Seoane E, Rhoton Jr A L. Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery. 1999; 44 553-560
- 3 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg. 1983; 58 824-831
- 4 Dolenc V V. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg. 1985; 62 667-672
- 5 Dolenc V V. Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien). 1994; 130 55-65
- 6 Bambakidis N C, Kakarla U K, Kim L J et al.. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery. 2007; 61 202-209
- 7 Little A S, Jittapiromsak P, Crawford N R et al.. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension. Neurosurgery. 2008; 62(5 Suppl 2) ONS318-ONS323
- 8 Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986; 26 271-276
- 9 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991; 28 869-875
- 10 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery. 2006; 59 1019-1028
- 11 Laufer I, Anand V K, Schwartz T H. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. 2007; 106 400-406
- 12 Samii M, Tatagiba M, Carvalho G A. Resection of large petroclival meningiomas by the simple retrosigmoid route. J Clin Neurosci. 1999; 6 27-30
- 13 Tatagiba M, Samii M, Matthies C, Vorkapic P. Management of petroclival meningiomas: a critical analysis of surgical treatment. Acta Neurochir Suppl (Wien). 1996; 65 92-94
- 14 Koerbel A, Kirschniak A, Ebner F H, Tatagiba M, Gharabaghi A. The retrosigmoid intradural suprameatal approach to posterior cavernous sinus - Microsurgical anatomy. Eur J Surg Oncol. 2008; , April 2 (Epub ahead of print)
- 15 Ebner F H, Koerbel A, Kirschniak A, Roser F, Kaminsky J, Tatagiba M. Endoscope-assisted retrosigmoid intradural suprameatal approach to the middle fossa: anatomical and surgical considerations. Eur J Surg Oncol. 2007; 33 109-113
- 16 Koerbel A, Gharabaghi A, Safavi-Abbasi S et al.. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. Eur J Surg Oncol. 2008; , April 21 (Epub ahead of print)
Florian H EbnerM.D.
Department of Neurosurgery, Eberhard-Karls-University, Hoppe-Seyler-Street 3
72076 Tübingen, Germany
Email: florianebner@virgilio.it