How I do it: retrosigmoid intradural inframeatal petrosectomy
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HOW I DO IT - NEUROSURGERY GENERAL
How I do it: retrosigmoid intradural inframeatal petrosectomy Torstein R. Meling 1,2,3
&
Greg Zegarek 1 & Karl Schaller 1,2
Received: 29 June 2020 / Accepted: 15 September 2020 # The Author(s) 2020
Abstract Background Lesions infiltrating the petrous temporal bone are some of the most complex to treat surgically. Many approaches have been developed in order to address these lesions, including endoscopic endonasal, anterior petrosectomy, posterior petrosectomy, and retrosigmoid. Method We describe in a stepwise fashion the surgical steps of the retrosigmoid intradural inframeatal petrosectomy. Conclusion The retrosigmoid intradural inframeatal petrosectomy may afford satisfactory exposure with limited drilling and minimal disruption of perilesional anatomical structures. It can provide excellent surgical results, especially for soft tumors, while minimizing surgical morbidity. Keywords Surgery . Neurosurgery . Anatomy . Petrosectomy . Retrosigmoid . Brain tumor . Skull base
Introduction Lesions infiltrating the petrous temporal bone are certainly among the most difficult to treat in neurosurgery. Multiple approaches have been developed in order to access the petroclival space, and which approach is chosen should be assessed on a case-by-case basis [6, 8]. Each of these approaches, such as the endoscopic endonasal [2, 10], subtemporal [3], or anterior or combined petrous [5, 7] routes comes with certain built-in surgical comorbidities that must be accepted and explained to the patient [1]. We present a case of a grade II chondrosarcoma of the petrous bone (Fig. 1) operated (TRM) via the retrosigmoid intradural inframeatal
This article is part of the Topical Collection on Neurosurgery general Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04587-0) contains supplementary material, which is available to authorized users. * Torstein R. Meling [email protected]
petrosectomy (RESIP), and aim to discuss the advantages, but also the pitfalls and challenges involved.
Relevant surgical anatomy Multiple key anatomic landmarks must be evaluated [4, 9]. We rely on craniometric landmarks adjusted based on patient individual anatomy from preoperative imaging as well as neuronavigation and augmented reality. In planning the craniotomy, the transverse (TS) and sigmoid sinus (SS) must be identified. In charting the surgical trajectory, the pneumatization of the mastoid bone, the caudal cranial nerves (CNs), the jugular bulb, the superior and inferior petrosal sinuses (SPS, IPS), the acoustico-facial bundle, the internal acoustic canal (IAC), the petrous apex, the carotid canal, and Eustachian tube must be taken into account and outlined for the use of neuronavigation and augmented reality.
Description of the technique
1
Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
Patient positioning and preparation
2
Faculty of Medicine, University of Geneva, Geneva, Sw
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