Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
J Neurosurg. 2011 May;114(5):1294-8. doi: 10.3171/2010.6.JNS091461. Epub 2010 Jul 9.
The petrosal approach is based on sectioning the superior petrosal sinus (SPS) and the tentorium. However, the venous anatomy in certain situations forbids this maneuver. The authors have derived a technique that enables the SPS to be spared during the performance of the petrosal approach. They describe the anatomical basis of this technique and report on 2 cases in which the technique was applied.
Five alcohol-preserved cadaveric heads injected with colored silicone were used for bilateral dissection and demonstration of the technique. The described method was thoroughly investigated in these cadavers to assess its advantages, variabilities, and limitations. Subsequently, the technique was applied during the resection of petroclival tumors in 2 patients.
The authors were able to demonstrate that the approach provides good access to the petroclival area through both the middle and posterior fossa in cadavers. By deriving a new technique of applying the combined petrosal approach without cutting the SPS, the senior author (O.A.M.) managed to achieve total resection of a dumbbell-shaped trigeminal schwannoma in a 19-year-old woman and of a petroclival meningioma in a 49-year-old man.
This modification of the petrosal approach involving sparing of the SPS or cutting of the tentorium is an effective means for cases in which the venous anatomy mandates preservation of these structures.
岩下窦入路基于切开岩上窦（SPS）和小脑幕。然而，在某些情况下，静脉解剖结构禁止进行此操作。作者已经提出了一种可以在进行岩下窦入路时保留 SPS 的技术。他们描述了该技术的解剖学基础，并报告了 2 例应用该技术的病例。
使用 5 具灌注有色硅胶的防腐尸头进行双侧解剖和技术演示。在这些尸体中详细研究了所描述的方法，以评估其优点、可变性和局限性。随后，在 2 例岩斜区肿瘤切除中应用了该技术。
作者能够证明该入路通过中颅窝和后颅窝为岩斜区提供了良好的显露。通过提出一种不切开 SPS 而应用联合岩下窦入路的新技术，资深作者（O.A.M.）成功地切除了 1 例 19 岁女性的哑铃形三叉神经鞘瘤和 1 例 49 岁男性的岩斜脑膜瘤。
这种不切开 SPS 或小脑幕的岩下窦入路的改良是在静脉解剖结构需要保留这些结构的情况下的有效方法。
