A Combined Extradural-Intradural Technique for an En-Bloc Anterior Petrosectomy: A Cadaveric Feasibility Study.

Related Articles

A Combined Extradural-Intradural Technique for an En-Bloc Anterior Petrosectomy: A Cadaveric Feasibility Study.

World Neurosurg. 2019 Jan 09;:

Authors: Dones F, Kournoutas I, Vigo V, Di Bonaventura R, Raygor K, El-Sayed IH, Abla AA, Rubio RR

Abstract
INTRODUCTION: The anterior petrosectomy approach is among the most popular for exposure of the petroclival region. However, the complexity of the anatomy, drilling time, and risk of injury to neurovascular structures make this procedure especially challenging.
OBJECTIVE: Our study proposes a novel combined extradural-intradural technique for an en-bloc anterior petrosectomy-or one-piece Kawase(OPK)-while also charting the landmarks that define its surgical boundaries.
METHODS: The approach was performed on fourteen embalmed specimens. The OPK approach consists of three extradural drilling steps, followed by incision of the dura and skeletonization of the superior petrosal sinus, and culminates with two intradural drilling steps. The bone piece was then en-bloc removed and its maximum antero-posterior(AP), supero-inferior(SI) and medio-lateral(ML) lengths were recorded. Linear distances between main neurovascular landmarks were also measured using a stereotactic navigation system.
RESULTS: Mean measurements were 17.6±2.6 mm for the AP distance, 10.5±2.3 mm for the SI distance and 9.5±2.6 mm for ML distance. The medial linear distance from the mandibular nerve/greater superficial petrosal nerve to the internal carotid artery was 6.8± 1.3mm, to the facial hiatus was 11.6± 2.2mm and to the lateral internal acoustic canal (IAC) was 17.9± 1.8mm. The average distance from porus trigeminus to medial IAC was 19.4 mm.
CONCLUSION: Advantages of this technique include: wide exposure of the petroclival region, extensive visualization of critical structures via extradural and intradural corridors, and the minimization of bone drilling which may reduce heat damage. Clinical application of the illustrated technique will be required to test its reliability in different pathology subsets.

PMID: 30639606 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2T68FS2