1
|
Shibao S, Yoshida K. Simplified anterior transpetrosal approach without superior petrosal sinus and tentorial incision for lesions centered in Meckel's cave. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05584-9. [PMID: 37099067 DOI: 10.1007/s00701-023-05584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/08/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The anterior transpetrosal approach (ATPA) is an effective method to reach lesions in the petroclival region. This approach involves many steps, including superior petrosal sinus (SPS) ligation and tentorial cutting. It is sometimes unnecessary to perform all procedures in the ATPA for certain lesions, especially those centered in the Meckel's cave. Here, we present a simplified anterior transpetrosal approach (SATPA) without superior petrosal sinus and tentorial incision for lesions centered in the Meckel's cave as a modified ATPA. METHODS This study included 13 patients treated with SATPA. The initial steps of SATPA are similar to ATPA, excluding a middle cranial fossa dural incision, SPS dissection, or tentorial incision. Histological examination was performed to understand the membrane structure of the trigeminal nerve, which runs through the Meckel's cave. RESULTS Pathology revealed trigeminal schwannoma (n=11), extraventricular central neurocytoma (n=1), and a metastatic tumor (n=1). The average tumor size was 2.4 cm. The total removal rate was 76.9% (10/13). Permanent complications included trigeminal neuropathy in four cases and cerebrospinal fluid leakage in one case. Histological examination revealed the trigeminal nerve traverses the subarachnoid space from the posterior fossa subdural space to the Meckel's cave and is covered with the epineurium in the inner reticular layer. CONCLUSIONS We used SATPA for lesions located in the Meckel's cave identified using histological examination. This approach may be considered for small- to medium-sized lesions centered in the Meckel space. CLINICAL TRIAL REGISTRATION NUMBER None.
Collapse
Affiliation(s)
- Shunsuke Shibao
- Department of Neurosurgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
2
|
Mincă DI, Rusu MC, Rădoi PM, Hostiuc S, Toader C. A New Classification of the Anatomical Variations of Labbé’s Inferior Anastomotic Vein. Tomography 2022; 8:2182-2192. [PMID: 36136879 PMCID: PMC9498553 DOI: 10.3390/tomography8050183] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The inferior anastomotic vein of Labbé (LV) courses on the temporal lobe, from the sylvian fissure towards the tentorium cerebelli and finishes at the transverse sinus (TS). The importance of the LV topography is related to skull base neurosurgical approaches. Based on the hypothesis of the existence of as yet unidentified anatomical possibilities of the LV, we aimed through this research to document the superficial venous topographic patterns at the lateral and inferior surfaces of the temporal lobe. (2) Methods: A retrospective cohort of 50 computed tomography angiograms (CTAs) of 32 males and 18 females was documented. (3) Results: Absent (type 0) LVs were found in 6% of cases. Anterior (temporal, squamosal–petrosal–mastoid, type 1) LVs were found in 12% of cases. LVs with a posterior, temporoparietal course (type 2) were found to be bilateral in 46% of cases and unilateral in 36% of cases. Type 3 LVs (posterior, parietooccipital) were found to be bilateral in 8% and unilateral in 32% of cases. In 24% of cases, duplicate LVs were found that were either complete or incomplete. A quadruplicate LV was found in a male case. On 78 sides, the LV drained either into a tentorial sinus or into the TS. (4) Conclusions: The anatomy of the vein of Labbé is variable in terms of its course, the number of veins and the modality of drainage; thus, it should determine personalized neurosurgical and interventional approaches. A new classification of the anatomical variations of Labbé’s vein, as detected on the CTAs, is proposed here (types 0–3).
Collapse
Affiliation(s)
- Dragoş Ionuţ Mincă
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Correspondence: (M.C.R.); (P.M.R.)
| | - Petrinel Mugurel Rădoi
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
- Correspondence: (M.C.R.); (P.M.R.)
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Corneliu Toader
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
| |
Collapse
|
3
|
Serrato-Avila JL, Paz Archila JA, Costa MDSD, Rocha PR, Marques SR, Moraes LOCD, Cavalheiro S, Yağmurlu K, Lawton MT, Chaddad-Neto F. Microsurgical approaches to the cerebellar interpeduncular region: qualitative and quantitative analysis. J Neurosurg 2022; 136:1410-1423. [PMID: 34678772 DOI: 10.3171/2021.6.jns204457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided. METHODS Three approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach. RESULTS The OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05). CONCLUSIONS To reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.
Collapse
Affiliation(s)
| | | | | | - Paulo Ricardo Rocha
- 2Laboratory of Microneurosurgery Anatomy, and
- 3Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Brazil
| | | | | | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery
- 2Laboratory of Microneurosurgery Anatomy, and
| | - Kaan Yağmurlu
- 4Departments of Neurosurgery and
- 5Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Michael T Lawton
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery
- 2Laboratory of Microneurosurgery Anatomy, and
- 7Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
| |
Collapse
|
4
|
Martínez-Pérez R, Tsimpas A, Marin-Contreras F, Maturana R, Hernandez-Alvarez V, Labib MA, Poblete T, Rubino P, Mura J. The Minimally Invasive Posterolateral Transcavernous-Transtentorial Approach. Technical Nuances, Proof of Feasibility, and Surgical Outcomes Throughout a Case Series of Sphenopetroclival Meningiomas. World Neurosurg 2021; 155:e564-e575. [PMID: 34478889 DOI: 10.1016/j.wneu.2021.08.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sphenopetroclival (SPC) meningiomas are considered among the most complex skull-base neoplasms to approach surgically. We aim to determine whether some SPC meningiomas can be safely and effectively treated using a modified minimally invasive pterional posterolateral transcavernous-transtentorial approach (MIPLATTA). METHODS Fourteen patients harboring SPC meningiomas were surgically treated through a MIPLATTA. MIPLATTA includes a minipterional craniotomy, anterior extradural clinoidectomy, peeling of the temporal fossa, decompression of cranial nerves (CNs) in the cavernous sinus, and sectioning of the tentorium to reach the upper part of the posterior fossa. RESULTS Gross total resection was achieved in 11 of 14 patients (78%), whereas near-total resection was accomplished in the other 3 patients (22%), each of whom underwent a further complementary retrosigmoid approach for gross total tumor resection. There were no deaths, and 13 of 14 patients were independent at 6 months follow-up (modified Rankin Scale score ≤2). One patient had pontine infarction after the procedure and experienced moderate disability at follow-up (modified Rankin Scale score 3). All patients had some degree of CN impairment. Of 38 cranial neuropathies, 15 (39%) improved, 20 (53%) remained stable, and 3 (8%) worsened postoperatively. Four new CN deficits were observed postoperatively in 3 patients (fourth CN, 2 patients; third CN, 1; fifth CN, 1). CONCLUSIONS MIPLATTA is a useful and safe treatment alternative that allows resection of large SPC tumors with dominant invasion of cavernous sinus and middle fossa, preserves hearing and facial motor function, and provides good chances of recovery of visual and oculomotor deficits.
Collapse
Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurosurgery, Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile.
| | - Asterios Tsimpas
- Department of Neurosurgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Francisco Marin-Contreras
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | - Rolando Maturana
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | | | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tomas Poblete
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Anatomy and Legal Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Pablo Rubino
- Department of Neurosurgery, Hospital el Cruce, Buenos Aires, Argentina
| | - Jorge Mura
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Neurological Sciences, Universidad de Chile, Santiago, Chile; Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
| |
Collapse
|
5
|
Martínez-Pérez R, Silveira-Bertazzo G, Rangel GG, Albiña P, Hardesty D, Carrau RL, Prevedello DM. The historical perspective in approaches to the spheno-petro-clival meningiomas. Neurosurg Rev 2019; 44:51-60. [PMID: 31802287 DOI: 10.1007/s10143-019-01197-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/20/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
The current literature regarding surgical treatment for tumors in the sphenopetroclival (SPC) region is merely scarce. Through a comprehensive literature review, we investigated the indications, outcomes, and complications of different surgical approaches to the SPC meningiomas. Given its complicated relationship between these slow-progression tumors and some critical neurovascular structures in the SPC region, surgical treatment of these tumors faces the challenge of achieving a maximal grade of resection, while preserving patient functionality. The development of new surgical techniques and approaches in recent years have permitted the advancement in the treatment of these tumors, with acceptable rates of morbidity and mortality. The choice of a surgical approach as a treatment for the lesion depends mainly on the type of tumor extension, surgeon's preferences, and the displacement of neurovascular structures. Rather than focusing on one single strategy of treatment, the skull-base surgeon should tailor the approach based on the origin and features of the lesion; as well as the peculiarities of the surgical anatomy. This strategy aims to decrease morbidity and to optimize tumor resection and patient quality of life.
Collapse
Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.
| | - Giuliano Silveira-Bertazzo
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA
| | - Gustavo G Rangel
- Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Pablo Albiña
- Department of Neurosurgery, Hospital Barros Luco, Universidad de Santiago de Chile, Santiago, Chile
| | - Douglas Hardesty
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave, Columbus, OH, 43215, USA.,Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| |
Collapse
|