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J Neurol Surg B Skull Base 2022; 83(05): 526-535
DOI: 10.1055/s-0041-1741067
Original Article

Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers

Thanapong Loymak
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
,
Evgenii Belykh 
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
,
Irakliy Abramov
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
,
Somkanya Tungsanga
2   Division of Nephrology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
,
Christina E. Sarris
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
,
Andrew S. Little
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
,
Mark C. Preul
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
› Author Affiliations Funding This study was supported by funds from the Newsome Chair in Neurosurgery Research held by M.C.P. at Barrow Neurological Institute and from the Barrow Neurological Foundation.
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Abstract

Objectives Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies.

Design This study presents anatomical dissection and quantitative analysis.

Setting Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques.

Participants Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides.

Main Outcomes and Measures Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume.

Results The IMP technique provided a greater area of exposure (p < 0.01) and bone resection volume (p < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique (p < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [p = 0.04], anterior inferior cerebellar artery [p < 0.01], proximal part of the cisternal CN VI segment [p = 0.02]) and IP (flocculus [p = 0.02] and the proximal [p = 0.02] and distal parts [p = 0.02] of the CN VII/VIII complex) techniques.

Conclusion Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques.

Keywords

endoscopic endonasal approach - petroclival - petrosectomy - transpterygoid

Note

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript. E.B. is currently at the Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States.




Publication History

Received: 19 January 2021

Accepted: 12 November 2021

Article published online:
14 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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