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Vidal CHF, Figueiredo EG, Hazin GF, Hahn Y, Leal MC, Coimbra CJ. Partial Labyrinth Removal Restricted to the Superior Semicircular Canal in Focal Combined Transpetrosal Approach: Description and Illustrative Cases. Oper Neurosurg (Hagerstown) 2024; 26:442-451. [PMID: 37878477 DOI: 10.1227/ons.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The labyrinthine structures obstruct the surgical view of the deep petroclival region in the transpetrosal approach. Historically, labyrinthectomy and removal of all 3 semicircular canals, with resultant deafness, was used in patients with ipsilateral functional hearing deficits to improve access. The advent and systematization of superior and posterior semicircular canal removal (transcrusal approach) with good rates of hearing preservation has allowed a redefinition of the possibility of partial labyrinthectomy in patients without previous hearing deficits. The present manuscript is intended to describe a technical refinement of partial labyrinthectomy during focal combined petrosectomy, offering a customization of the approach through the selective removal of the superior semicircular canal for specific types of tumors. METHODS The use of the technique is demonstrated through surgical drawings, pictures, and videos. The rationale to indicate this new approach is discussed based on clinical cases. RESULTS Three illustrative clinical cases (petroclival meningiomas) are demonstrated. Functional hearing on the approach side has been preserved in all of them. CONCLUSION The focal combined transpetrosal approach associated with the superior semicircular canal resection has been a promising surgical technique in the treatment of selected petroclival tumors. It has the potential to further decrease the risks of postoperative auditory and vestibular dysfunctions associated with labyrinthectomies.
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Affiliation(s)
- Claudio H F Vidal
- Department of Neurosurgery, Hospital Getúlio Vargas, Recife , Brazil
- Postdoctoral Program, Faculdade de Medicina da Universidade de São Paulo, São Paulo , Brazil
| | - Eberval G Figueiredo
- Postdoctoral Program, Faculdade de Medicina da Universidade de São Paulo, São Paulo , Brazil
- Division of Neurological Surgery, University of São Paulo, São Paulo , Brazil
| | | | - Yoav Hahn
- Skull Base Surgery Center, Baylor University Medical Center, Dallas , Texas , USA
- Minimally Invasive Brain Surgery Center, Medical City Dallas Hospital, Dallas , Texas , USA
| | - Mariana C Leal
- Division of Otorhinolaryngology, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife , Brazil
| | - Caetano J Coimbra
- Skull Base Surgery Center, Baylor University Medical Center, Dallas , Texas , USA
- Minimally Invasive Brain Surgery Center, Medical City Dallas Hospital, Dallas , Texas , USA
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Lockwood J, Mathkour M, Nerva JD, Iwanaga J, Bui CJ, Vale FL, Dumont AS, Tubbs RS. Anatomic Study Quantifying the Relationship Between the Arcuate Eminence and the Root of the Zygoma: Application to Skull Base Surgery. World Neurosurg 2020; 146:e773-e778. [PMID: 33181377 DOI: 10.1016/j.wneu.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to define the structural relationship between the arcuate eminence (AE) and a known fixed external bony landmark, the root of the zygoma (ZR), and to determine its reliability as a consistent guide for guiding surgical approaches. To our knowledge, this is the only anatomic study to quantify the relationship between the AE and ZR. METHODS Twenty-one dry temporal bones were measured using digital calipers. The distance from the posterior aspect of the ZR to the midpoint of the AE was measured. Additionally, the anteroposterior distance between the ZR and AE and vertical distance between the 2 structures were measured. Student's t-test was used to compare the left and right sides. RESULTS An AE was found in every specimen. The mean ZR to AE distance was 30.9 mm. On most sides (91%), the ZR was located more inferiorly than the AE with a mean distance of 3 mm between the 2 structures. The mean distance between the AE and ZR was 17 mm. On all sides, the AE was located posterior to the ZR. No significant differences were found between sides. No anatomic variations or pathologic conditions were noted in any of the specimens. CONCLUSIONS The ZR is an easily identifiable and consistent bony landmark often used by skull base surgeons. In this investigation, we measured the anatomic relationships between the ZR and AE. Such data might assist in planning surgical trajectories and minimizing complications when skull base pathologies are approached.
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Affiliation(s)
- Joseph Lockwood
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - John D Nerva
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - C J Bui
- Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
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Yang H, Li M, Chen G, Liang J, Bao Y, Li M, Ling F. Using the Arcuate Eminence-Trigeminal Notch Line to Localize the Anterior Wall of the Internal Auditory Canal in a Subtemporal Approach: An Anatomical Study. J Neurol Surg B Skull Base 2020; 82:e196-e202. [PMID: 34306937 DOI: 10.1055/s-0040-1701601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022] Open
Abstract
Background This article aims to describe the regional anatomy of the anterior end of the arcuate eminence, the lateral end of the trigeminal notch, and the line connecting the two (i.e., the arcuate eminence-trigeminal notch line [ATL]) and to determine whether the ATL could be used as a landmark for localizing the internal auditory canal (IAC). Methods Twenty sides of the middle cranial fossae were examined. The anterior end of the arcuate eminence, the lateral end of the trigeminal notch, the ATL, and other crucial structures were exposed. The relevant distance and angle of related structures in the anterior wall of the petrosal bone were measured. Results The anterior end of the arcuate eminence and the lateral end of the trigeminal notch could be identified in all specimens. The anterior end of the arcuate eminence lay over the geniculate ganglia and the vestibule area, and could be visualized directly or determined from the intersection of the long axes of the greater superficial petrosal nerve and arcuate eminence. On the petrous ridge, the lateral end of the trigeminal notch was also the transitional point of the suprameatal tubercle and trigeminal notch. The ATL corresponded to the projection of the anterior wall of the IAC on the anterior surface of the petrous bone. Conclusion The ATL corresponded to the projection of the anterior wall of the IAC on the anterior petrous surface and could be used as an alternative landmark for localizing the anterior wall of the IAC.
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Affiliation(s)
- Haifeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mengjun Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
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Kara E, Öztürk K, Oktay E, Hamzaoğlu V, Uzmansel D, Vayisoğlu Y, Özalp H, Farsak M, Aladağ ZC, Pütürgeli T, Eti CM, Dağtekin A, Türkegün M, Ümit Talas D. The Predictability Precision of Superior Semicircular Canal Through Radiological Assessment and Microanatomical Dissection. J Int Adv Otol 2019; 14:290-294. [PMID: 29460825 DOI: 10.5152/iao.2018.4428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is still ongoing research on the relationship of arcuate eminence (AE) and superior semicircular canal (SSC). We aimed to evaluate the precision of predictability of SSC through the morphology of AE via radiological means. MATERIALS AND METHODS This investigation is performed on 12 dry skulls belonging to Mersin University Medical Faculty department of anatomy. Computed tomography (CT) assessment is performed with 0.5-mm-thin sections temporal bone algorithm on dry skulls which were marked with fixated copper wire by scotch tapes on the most prominent part of the middle fossa floor assuming the location of AE. The data are reformatted on the workstation with vitrea 2.0. The distances of the determined three points including lateral (A), apical (B), and medial (C) of the SSC and the copper wire are measured radiologically. Also, the height between the most apical part of the SSC to the floor of the skullbase (H) is measured. The angles between the placed copper wires and the SSC (E) are calculated. The angle between SSC and the midpoint of the IAC (F) and SSC to the sulcus of the greater GSPN (G) were measured. The nearest distance was measured between the most posterior part of the SSC and the point marked by the perpendicular line drawn from the medial border of the petrous bone to the most posterior part of the internal auditory canal (IAC) (D). RESULTS The right and left A, B, and C distances are 2.54+/- 2.75, 3.67+/-3.16, 5.85+/-3.77; 2.92+/-2.24, 3.68+/-2.93, 6.09+/-3.40, respectively. We could not find any statistical significance when the right A, B, and C distances were compared with the left values. Examination of the values revealed that C distance is greater than the A distance of the same side both for right (p=0.040) and left (p=0.022) measurements. The calculated left and right E angles are 30.313+/-12.838, and 35.558+/-18.437 degrees, respectively. Statistical significance was not found between the right and left angles. The right and left F, G angles were 53.17, 47.25; 93.58, 100.92 degrees; and D distances are 8.01, 8.13 millimeters, respectively. Statistical significance was not found when right and left E, F, G angles and D distances were compared. Among 12 left and 12 right sides, the copper wire was found to be nearly overlapping to SSC in two in the right and only one in the left. CONCLUSION This study reveals that there is a great variability predicting the exact location of SSC through the prominence of AE. Complementary studies are needed with greater number of dry skulls and cadavers. Comparison of different hypothesis including the effect of temporal lobe sulcus is to be discussed to better enlighten the exact relationship of the aforementioned anatomical structures.
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Affiliation(s)
- Engin Kara
- Department of Radiology, Mersin University School of Medicine, Mersin, Turkey
| | - Kübra Öztürk
- Mersin University School of Medicine, Mersin, Turkey
| | - Ezgi Oktay
- Mersin University School of Medicine, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Deniz Uzmansel
- Department of Anatomy, Mersin University School of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Farsak
- Mersin University School of Medicine, Mersin, Turkey
| | | | - Tuğçe Pütürgeli
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Can Mehmet Eti
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Merve Türkegün
- Department of Biostatictics, Mersin University School of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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