Endoscope-Assisted Microsurgical Resection of a Petroclival Artificial Tumor Model with Retrosellar Extension Using a Retrosigmoid Approach: A Cadaveric Study and Analysis of Supratentorial Working Area

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Varun Kshettry ◽  
Silky Chotai ◽  
Jack Hou ◽  
Tariq Lamki ◽  
Mario Ammirati
Keyword(s):  
Tumor Model ◽  
Cadaveric Study ◽  
Retrosigmoid Approach ◽  
Microsurgical Resection

Microsurgical Resection of Intracanalicular Vestibular Schwannoma via Retrosigmoid Approach: 3-Dimensional Operative Video

2022 ◽  
Vol 157 ◽  
pp. 1
Author(s):  
Guilherme H.W. Ceccato ◽  
Júlia S. de Oliveira ◽  
Pedro H.S. Neto ◽  
Nick D. de Carvalho ◽  
Vinícius N. Coelho ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Retrosigmoid Approach ◽  
3 Dimensional ◽  
Microsurgical Resection

scholarly journals Retrosigmoid Approach: A Simple and Safe Way to Resect Intrinsic Pontomedullary Lesions

2019 ◽  
Vol 81 (03) ◽  
pp. 223-231
Author(s):  
José M. González-Darder ◽  
Pau Capilla-Guasch ◽  
Luis Real-Peña
Keyword(s):  
Decision Making ◽  
Cranial Nerves ◽  
Radical Resection ◽  
Retrosigmoid Approach ◽  
Functional Improvement ◽  
Partial Recovery ◽  
Fiber Tracts ◽  
Microsurgical Resection ◽  
High Degree ◽  
White Fiber

Objectives The main objective of this article is to describe a simple and safe protocol for the microsurgical management of ventrally located intrinsic pontomedullary lesions based on the retrosigmoid approach, cortectomy performed utilizing safe entry zones of the pons and medulla, and a delicate microsurgical resection. The intraoperative protocol includes redundant procedures that provide security in decision-making during surgery. Design A prospective series of 11 cases is presented. All patients were studied following the same clinical and imaging workup. A regular retrosigmoid craniotomy surgical approach was utilized. The peritrigeminal area in the pons and the olivary area in the medulla were considered as the safe entry zones. Neuronavigation of the white fiber tracts and electrophysiological monitoring were used as intraoperative aids to locate the lesions, the safe entry zones, and the placement of the cortectomy. Results Six lesions were pontine, two medullary, and the remaining six pontomedullary. Eight lesions were cavernomas, while the remaining three tumors. Overall, we obtained a postoperative functional improvement in the affected cranial nerves in 90.1% of the patients and a total or partial recovery of long ascending or descending pathway symptoms in 72.3% of the patients. All the patients were satisfied with the procedure and the results. Conclusions Radical resection of ventral intrinsic pontomedullary lesions displays a high degree of intraoperative reliability, and a good clinical result is possible using simple surgical procedures. The anatomical references are the first element in the decision-making process during surgery.

Retrolabyrinthine transsigmoid approach to complex parabrainstem tumors in the posterior fossa

2021 ◽  
pp. 1-6
Author(s):  
Yusuke Kinoshita ◽  
Ali R. Zomorodi ◽  
Allan H. Friedman ◽  
Hikari Sato ◽  
James H. Carter ◽  
...  
Keyword(s):  
Clinical Study ◽  
Clinical Outcomes ◽  
Posterior Fossa ◽  
Sigmoid Sinus ◽  
Cadaveric Study ◽  
Retrosigmoid Approach ◽  
Endolymphatic Sac ◽  
Working Space ◽  
Formidable Challenge ◽  
Subtotal Removal

OBJECTIVE The surgical management of large and complex tumors of the posterior fossa poses a formidable challenge in neurosurgery. The standard retrosigmoid craniotomy approach has been performed at most neurosurgical centers; however, the retrosigmoid approach may not provide enough working space without significant retraction of the cerebellum. The transsigmoid approach provides wider and shallower surgical fields; however, there have been few clinical and no cadaveric studies on its usefulness. In the present study, the authors describe the transsigmoid approach in clinical cases and cadaveric specimens. METHODS For the clinical study, the authors retrospectively reviewed the medical records and operative charts of patients who had been surgically treated for parabrainstem tumors using the transsigmoid approach between 1997 and 2019. They analyzed patient demographic and clinical data, as well as surgical and clinical outcomes. In the cadaveric study, they compared the surgical views obtained in different approaches (retrosigmoid, presigmoid, retrolabyrinthine, and transsigmoid) and measured the sigmoid sinus width at the level of the endolymphatic sac and the distance between the anterior edge of the sigmoid sinus and the endolymphatic sac on 35 sides in 19 cadaveric specimens. RESULTS A total of 21 patients (6 males and 15 females) with a mean age of 42.2 (range 15–67) years were included in the clinical study. Eleven patients had meningioma, 7 had vestibular schwannoma, 2 had hemangioblastoma, and 1 had epidermoid cyst. Gross-total, near-total, and subtotal removal were achieved in 7 (33.3%), 3 (14.3%), and 11 (52.4%) patients, respectively. In the cadaveric study, 19 cadaveric specimens were used. The sigmoid sinus was cut in the middle, and the incision was extended from the retrosigmoid to the presigmoid dura. The dura was then retracted upward and downward like opening a door. The results indicated that this technique can widen the operative field anteriorly by approximately 2 cm as compared to the retrosigmoid approach and provides a better view anterior to the brainstem. CONCLUSIONS The transsigmoid approach is useful for complex parabrainstem tumors in the posterior fossa because it provides a wider and shallower operative view with less retraction of the cerebellum. This enables safer tumor removal with less damage to important structures in the posterior fossa, resulting in better operative and clinical outcomes.

scholarly journals Quantitative evaluation of different far lateral approaches to the cranio-vertebral junction using the microscope and the endoscope: a cadaveric study using a tumor model

2018 ◽  
Vol 160 (4) ◽  
pp. 695-705 ◽  
Author(s):  
Pengfei Wu ◽  
Roberto Colasanti ◽  
Jungshun Lee ◽  
Alba Scerrati ◽  
Serdar Ercan ◽  
...  
Keyword(s):  
Quantitative Evaluation ◽  
Tumor Model ◽  
Cadaveric Study ◽  
Far Lateral

scholarly journals Microsurgical resection of an enlarging lateral pontomedullary cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V24
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel-Castilla
Keyword(s):  
Cranial Nerve ◽  
Cavernous Malformation ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Lateral Aspect ◽  
Total Resection ◽  
Lower Cranial Nerve ◽  
Postoperative Mri ◽  
Microsurgical Resection ◽  
Pontomedullary Junction

The extended retrosigmoid approach provides an excellent corridor to the lateral aspect of the pontomedullary junction (PMJ).1,2 This video demonstrates a microsurgical resection of a progressive enlarging cavernous malformation (CM) of the PMJ. The patient is a 33-year-old woman with progressive symptoms, including right facial droop, left hemianesthesia, diplopia, and nystagmus. The patient underwent a right extended retrosigmoid approach with intraoperative neuronavigation and neuromonitoring. Lower cranial nerve dissection allowed access to the lateral PMJ. A longitudinal corticotomy was performed above the glossopharyngeal. The CM was removed in a piecemeal fashion. Postoperative MRI confirmed gross-total resection and the patient remained neurologically stable.The video can be found here: https://youtu.be/K_TtiTo1RsQ.

Sign in / Sign up

Export Citation Format

Share Document