1
|
Gilkes A, Rajaram-Gilkes M, Cardona JJ, Reina F, Carrera A, Iwanaga J, Dumont AS, Donofrio CA, Badaloni F, Fioravanti A, Tubbs RS. The Occipitalis Muscle as an Adjunct Superficial Landmark for the Transverse Sinus and Transverse-Sigmoid Junction: An Anatomical Study With Application to Posterior Cranial Fossa Surgery. Cureus 2023; 15:e39723. [PMID: 37398761 PMCID: PMC10310057 DOI: 10.7759/cureus.39723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Although neuronavigation systems are widely used for identifying deep intracranial structures, additional superficial anatomical landmarks can be useful when this technology is not available or is not working properly. Herein, we investigate the potential of the occipitalis muscle (OM), rarely mentioned in neurosurgical literature, as a superficial landmark for the transverse sinus (TS) and transverse-sigmoid sinus junction (TSJ). METHODS Eighteen adult cadaveric heads underwent dissection. The borders of the OM were identified and measured. The muscle was then removed and the bone underlying the muscle was drilled. The relationships between the OM and the underlying dural venous sinuses were then investigated by using a surgical microscope. RESULTS The OM is a quadrangular-shaped muscle, that invariably crosses the lambdoid suture, showing relationships with the TS inferiorly and the TSJ laterally. The medial border was located a mean of 2.7 cm from the midline and its lower edge was a mean of 1.6 cm above the TS. The inferior border was found between the lambdoid suture and the superior nuchal line in all the specimens. The medial half of the inferior margin was placed on average 1.1 cm superiorly to the TS while the lateral margin ran just above or over the TS. The lateral border was located a mean of 1.1 cm medially to the asterion and approximated the mastoid notch, being within 1-2 cm from it. The TSJ was between 2.1 and 3.4 cm lateral to OM lateral border. CONCLUSION A combination of superficial anatomical landmarks can be useful for surgical planning. We found that the OM represents a valuable aide for neurosurgeons and is a reliable landmark for the deeper-lying TS and TSJ.
Collapse
Affiliation(s)
- Aishwarya Gilkes
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
| | | | - Juan J Cardona
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - Francisco Reina
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA) Faculty of Medicine, University of Girona, Girona, ESP
| | - Ana Carrera
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA) Faculty of Medicine, University of Girona, Girona, ESP
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JPN
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - Carmine Antonio Donofrio
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, Faculty of Medicine, University of Brescia, Brescia, ITA
- Department of Neurosurgery, ASST Cremona, Cremona, ITA
| | - Filippo Badaloni
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
| |
Collapse
|
2
|
Jian ZH, Li JY, Wu KH, Li Y, Li SX, Chen HD, Chen G. Surgical Effects of Resecting Skull Base Tumors Using Pre-operative Multimodal Image Fusion Technology: A Retrospective Study. Front Neurol 2022; 13:895638. [PMID: 35645981 PMCID: PMC9133916 DOI: 10.3389/fneur.2022.895638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo analyze the surgical effects of resecting skull base tumors using multimodal three-dimensional (3D) image fusion technology in the neurosurgery department and present some typical cases.MethodsFrom October 2019 to October 2021, we included 47 consecutive patients with skull base tumors in the Neurosurgery Department at Zhuhai People's Hospital in this study. Pre-operative head computed tomography and magnetic resonance imaging data acquisition was performed using the GE AW workstation software for registration fusion, image fusion, and 3D reconstruction. The surgical approach and surgical plan were designed based on the multimodal 3D image, and the resection rate, complication rate, and operative time of the surgery using the multimodal image fusion technique were analyzed.ResultsThe reconstructed multimodal 3D images precisely demonstrated the size, location, and shape of the tumor along with the anatomical relationship between the tumor and surrounding structures, which is consistent with the intraoperative findings. Among 47 patients, 39 patients (78.7%) underwent total resection, 5 (14.9%) underwent subtotal resection, and 3 (6.4%) underwent partial resection. The mean operative time was 4.42 ± 1.32 h. No patient died during the inpatient period. Post-operative complications included 6 cases of cerebrospinal fluid leakage (14.9%), 3 cases of intracranial infection (6.4%), 6 cases of facial paralysis (12.8%), 2 cases of dysphagia (4.3%), and 1 case of diplopia (2.1%), all of which were improved after symptomatic treatment. The application value of pre-operative 3D image fusion technology was evaluated as outstanding in 40 cases (85.1%) and valuable in 7 cases (14.9%).ConclusionsPre-operative multimodal image fusion technology can provide valuable visual information in skull base tumor surgery and help neurosurgeons design the surgical incision, choose a more rational surgical approach, and precisely resect the tumor. The multimodal image fusion technique should be strongly recommended for skull base tumor surgery.
Collapse
Affiliation(s)
- Zhi-heng Jian
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Jia-yan Li
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Kai-hua Wu
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Yu Li
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Shi-xue Li
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Hai-dong Chen
- Department of Radiology, Zhuhai's People Hospital, Zhuhai, China
| | - Gang Chen
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
- *Correspondence: Gang Chen
| |
Collapse
|
3
|
Wu W, Li C, Zhu X, Guo X, Zhu HD, Lin Z, Liu H, Mou Y, Zhang J. Application of Surface Landmarks Combined with Image-Guided Sinus Location in the Retrosigmoid Approach and their Clinic-Image Relationship Analysis. J Neurol Surg B Skull Base 2022. [DOI: 10.1055/a-1837-6752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives: During craniotomy for cerebellopontine angle (CPA) lesions, the exact exposure of the margin of the venous sinuses complex remains an essential but risky part of the procedure. Here, we revealed the exact position of the asterion and sinus complex by combining preoperative image information and intraoperative cranial landmarks, and analyzed their clinic-image relationship.
Methods: Ninety-four patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. To determine the exact location of the sigmoid sinus and the transverse sinus and sigmoid sinus junction (TSSJ), we used preoperative images, such as computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks. The distance between the asterion and the sigmoid sinus was measured using MRI T1 sequences with gadolinium and/or the CT bone window.
Results: In 94 cases of retrosigmoid craniotomies, the asterion lay an average of 12.71 mm on the posterior to the body surface projection to the TSSJ. Intraoperative cranial surface landmarks were used in combination with preoperative image information to identify the distance from the asterion to the sigmoid sinus at the transverse sinus level, allowing for an appropriate initial burr-hole (the margin of the TSSJ).
Conclusions: By combining intraoperative anatomical landmarks and preoperative image information, the margin of the TSSJ, in particular, the inferior margin of the transverse sinus, can be well and thoroughly identified in the retrosigmoid approach.
Collapse
|
4
|
Jian ZH, Sheng MF, Li JY, Li Y, Weng ZJ, Chen G. Precise Localization in Craniotomy With a Retrosigmoid Keyhole Approach: Microsurgical Anatomy and Clinical Study. Front Surg 2022; 9:809098. [PMID: 35495767 PMCID: PMC9046933 DOI: 10.3389/fsurg.2022.809098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed to explore a method of precise localization within craniotomy based on skull anatomical landmarks via the suboccipital retrosigmoid approach. Method Craniometric measurements were taken from 15 adult dry skulls and eight cadaver head specimens. In the anatomical study, the keypoint corresponded to the transverse-sigmoid sinus junction's corresponding point on the external surface of the temporal mastoid process, eight cadaveric heads underwent a simulated craniotomy using the suboccipital retrosigmoid approach. The center of the burr hole is precisely oriented 12 mm vertically above the top point of the mastoid groove based on the line between the infraorbital margin and the upper edge of the external auditory canal. Clinical application was verified in clinical surgery by evaluating the accuracy, safety, rapidity, and minimal invasiveness of the procedure in 29 patients. Result No venous sinus injuries were observed. Within clinical application, 29 patients underwent craniotomy using the suboccipital retrosigmoid approach. The operative area was clearly exposed in all patients and the microsurgical anatomy of the intracranial region after the dura mater incision was satisfactory. No venous sinus ruptures were observed. The average craniectomy time was 27.02 ± 0.86 min. The diameter of the bone window was 1.7–2.9 cm. Conclusion We conclude that the method can ensure safe, accurate, and rapid craniotomy with good vision while avoiding injury to the venous sinus.
Collapse
Affiliation(s)
- Zhi-Heng Jian
- Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China
| | - Min-Feng Sheng
- Department of Neurosurgery, Second Affiliated Hospital, Soochow University, Suzhou, China
| | - Jia-Yan Li
- Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China
| | - Yu Li
- Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China
| | - Zhi-Jian Weng
- Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China
| | - Gang Chen
- Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China
- *Correspondence: Gang Chen
| |
Collapse
|
5
|
Sponton LS, Shaaban AT, Archavlis E, Alhoobi M, Nimer A, Conrad J, Kantelhardt SR, Ayyad A. Two-stage endoscopic assisted approach for large pineal region and falcotentorial meningioma: first stage paramedian supracerebellar infratentorial approach, second stage interhemispheric occipital transtentorial approach: surgical cases and anatomical study. Neurosurg Rev 2022; 45:1759-1772. [PMID: 34981260 DOI: 10.1007/s10143-021-01709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/23/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Resection of complex falcotentorial meningiomas, growing along the pineal region (PR), and posterior incisural space (PIS) represents a neurosurgical challenge. Here, we present our strategy for effective resection of large falcotentorial meningiomas applying a paramedian supracerebellar infratentorial and interhemispheric occipital transtentorial approach in staged surgeries. We further systematically compared the effectiveness of midline (MSIA) and paramedian (PSIA) supracerebellar infratentorial, as well as interhemispheric occipital transtentorial approaches (IOTA) to operate along the PR and PIS in 8 cadaveric specimens. The staged PSIA and IOTA enabled successful resection of both falcotentorial meningiomas with an uneventful postoperative course. In our anatomo-morphometrical study, superficial vermian veins at an average depth of 11.38 ± 1.5 mm and the superior vermian vein (SVV) at 54.13 ± 4.12 mm limited the access to the PIS during MSIA. MSIA required sacrifice of these veins and retraction of the vermian culmen of 20.88 ± 2.03 mm to obtain comparable operability indexes to PSIA and IOTA. Cerebellar and occipital lobe retraction averaged 14.31 ± 1.014 mm and 14.81 ± 1.17 mm during PSIA and IOTA respectively, which was significantly lower than during MSIA (p < 0.001). Only few minuscule veins were encountered along the access through PSIA and IOTA. The application of PSIA provided high operability scores around the pineal gland, ipsilateral colliculus and splenium, and acceptable scores on contralateral structures. The main advantage of IOTA was improving surgical maneuvers along the ipsilateral splenium. In summary, IOTA and PSIA may be advantageous in terms of brain retraction, vein sacrifice, and operability along the PR and PIS and can be effective for resection of complex falcotentorial meningiomas.
Collapse
Affiliation(s)
- Lucas Serrano Sponton
- Department of Neurosurgery, Mainz University Medical Center, Langenbeck Str. 1, 55131, Mainz, Germany.
| | - Ahmed Taha Shaaban
- Department of Neurosurgery, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Eleftherios Archavlis
- Department of Neurosurgery, Mainz University Medical Center, Langenbeck Str. 1, 55131, Mainz, Germany
| | - Mohammed Alhoobi
- Department of Neurosurgery, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Amr Nimer
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London, W6 8RF, UK
| | - Jens Conrad
- Department of Neurosurgery, Mainz University Medical Center, Langenbeck Str. 1, 55131, Mainz, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, Mainz University Medical Center, Langenbeck Str. 1, 55131, Mainz, Germany
| | - Ali Ayyad
- Department of Neurosurgery, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.,Department of Neurosurgery, Saarland University Medical Center, Kirrberger Str. 100, 66421, Homburg, Germany
| |
Collapse
|
6
|
Jian ZH, Sheng MF, Li JY, An DZ, Weng ZJ, Chen G. Developing a Method to Precisely Locate the Keypoint During Craniotomy Using the Retrosigmoid Keyhole Approach: Surgical Anatomy and Technical Nuances. Front Surg 2021; 8:700777. [PMID: 34692760 PMCID: PMC8531805 DOI: 10.3389/fsurg.2021.700777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To explore the precise location of the keypoint during craniotomy using the retrosigmoid keyhole approach. Methods: This study included 20 dry skulls and 10 wet cadaveric specimens. On the inner surface of dry skulls, the junction between the inferior margin of the transverse sinus (ITS) and the posterior margin of the sigmoid sinus (TSJ) was marked. The keypoint (D) was identified as the TSJ's corresponding point on the external surface of the temporal mastoid process (MP). The distance from the keypoint to the top point of the digastric groove, mastoidale, and asterion were noted (AD, BD, CD, respectively). A method to accurately locate the keypoint was developed based on these relationships. The developed method was used on the wet cadaveric specimens to evaluate its accuracy, safety, rapidity, and minimal invasion. Results: No significant difference was found between the AD, BD, and CD of the left and right sides. The drilling point was oriented on a straight line 12 mm above the top point of digastric groove, perpendicular to the Frankfort horizontal plane (FHP). In the cadaveric specimens, the operative area was clearly exposed. No venous sinus rupture occurred. The average craniotomy time was 28.74 ± 3.89 min. Conclusions: A potentially safe, accurate, and rapid craniotomy procedure was developed with the added advantage of preserving the visibility of the operating field and preventing venous sinus injury.
Collapse
Affiliation(s)
- Zhi-Heng Jian
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Min-Feng Sheng
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Soochow, China
| | - Jia-Yan Li
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - De-Zhu An
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Zhi-Jian Weng
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| | - Gang Chen
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University, China), Zhuhai, China
| |
Collapse
|
7
|
Giotta Lucifero A, Fernandez-Miranda JC, Nunez M, Bruno N, Tartaglia N, Ambrosi A, Marseglia GL, Galzio R, Luzzi S. The Modular Concept in Skull Base Surgery: Anatomical Basis of the Median, Paramedian and Lateral Corridors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021411. [PMID: 34437364 PMCID: PMC9179063 DOI: 10.23750/abm.v92is4.12115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
Introduction A thorough understanding of skull base anatomy is imperative to perform safely and effectively any skull base approach. In this article, we examine the microsurgical anatomy of the skull base by proposing a modular topographic organization in the median, paramedian, and lateral surgical corridors in relation to transcranial and endoscopic approaches. Methods Five dry skulls were studied focusing on the intracranial and exocranial skull base. Two lines were drawn parallel to the lateral border of the cribriform plate of the ethmoid bone and foramen lacerum, respectively. Lines 1 and 2 delimited the median, paramedian and lateral corridors of the skull base. The bony structures that formed each corridor were carefully reviewed in relation to the planning and execution of the skull base transcranial and endoscopic approaches. Results The midline corridor involves the crista galli, cribriform plate, planum and jugum sphenoidale, chiasmatic sulcus, tuberculum sellae, sellar region, dorsum sellae, clivus, and foramen magnum. The paramedian corridor includes the fovea ethmoidalis, the root of the lesser and greater sphenoid wing, anterior clinoid process, foramen lacerum, the upper half of the petro-occipital suture, and jugular tubercle. The lateral corridors include the orbital plates, sphenoid wings, squamosal and petrous parts of the temporal bone, caudal aspect of the petro-occipital suture, internal auditory canal, jugular foramen, the sulcus of the sigmoid sinus. Conclusion In-depth three-dimensional knowledge of skull base anatomy based on the modular concept of the surgical corridors is critical for the planning and execution of the transcranial and endoscopic approaches.
Collapse
Affiliation(s)
- Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | | | - Maximiliano Nunez
- Department of Neurological Surgery, Stanford University, Stanford, California, USA.
| | - Nunzio Bruno
- Division of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy.
| | - Nicola Tartaglia
- Surgical Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
| | - Antonio Ambrosi
- Surgical Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy..
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy.
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy..
| |
Collapse
|