Colasanti Roberto, Tailor Al-Rahim A, Gorjian Mehrnoush, Zhang Jun, Ammirati Mario
*Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery and ¶Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio; ‡Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; §International Neuroscience Institute, Hannover, Germany.
Neurosurgery. 2015 Mar;11 Suppl 2:181-9; discussion 189. doi: 10.1227/NEU.0000000000000632.
Different and often complex routes are available to deal with jugular foramen tumors with extracranial extension.
To describe a novel extension of the retrosigmoid approach useful to expose the extracranial area abutting the posterior fossa skull base.
A navigation-guided, endoscope-assisted retrosigmoid inframeatal approach was performed on 6 cadaveric heads in the semisitting position, displaying an area from the internal acoustic meatus to the lower cranial nerves and exposing the intrapetrous internal carotid artery. We then continued removing the temporal bone located between the sigmoid sinus and the hearing apparatus, reaching the infratemporal area just lateral to the jugular fossa. This drilling, which we refer to as posterolateral inframeatal drilling, has not previously been described. Drilling of the horizontal segment of the occipital squama allowed good visualization of the uppermost cervical internal carotid artery, internal jugular vein, and lower extracranial cranial nerves.
We were able to provide excellent exposure of the inframeatal area and of the posterior infratemporal fossa from different operative angles, preserving the neurovascular structures and the labyrinth in all specimens. The intradural operative window on the extracranial compartment was limited by the venous sinuses and the hearing apparatus and presented a mean width of 8.52 mm. Sigmoid sinus transection led to better visualization of the lateral half of the jugular foramen and of the uppermost cervical internal carotid artery.
The navigation-guided endoscope-assisted extended retrosigmoid inframeatal infratemporal approach provides an efficient and versatile route for resection of jugular foramen tumors with extracranial extension.
处理伴有颅外扩展的颈静脉孔区肿瘤有多种不同且通常较为复杂的手术入路。
描述一种改良的乙状窦后入路，用于显露后颅窝颅底毗邻的颅外区域。
在6具半坐位尸体头部上采用导航引导、内镜辅助的乙状窦后内听道入路，显露从内耳道至低位颅神经的区域，并暴露岩骨段颈内动脉。然后继续切除位于乙状窦和听觉器官之间的颞骨，到达颈静脉窝外侧的颞下区域。这种钻孔操作，我们称之为后外侧内听道钻孔，此前尚未见报道。枕骨鳞部水平段的钻孔可良好显露颈内动脉上段、颈内静脉及低位颅外颅神经。
我们能够从不同手术角度很好地显露内听道区域和颞下窝后部，所有标本中神经血管结构和迷路均得以保留。颅外腔的硬膜内手术视野受静脉窦和听觉器官限制，平均宽度为8.52 mm。横断乙状窦可更好地显露颈静脉孔外侧半及颈内动脉上段。
导航引导、内镜辅助的扩大乙状窦后内听道颞下入路为切除伴有颅外扩展的颈静脉孔区肿瘤提供了一种有效且通用的手术途径。
