Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):242-251. doi: 10.1093/ons/opaa356.
An extended retrosigmoid approach can offer sufficient space for clip reconstruction of some high-riding posterior inferior cerebellar artery (PICA) aneurysms.
To quantitatively investigate the glossopharyngo-cochlear triangle (GCT) and anatomic structures within it.
Extended retrosigmoid craniotomies were performed on 10 sides of cadaveric heads, and the GCT was identified in each specimen. The length of the base and the area of the GCT were measured. The depth of the vertebrobasilar system and the abducens nerve to the GCT were measured. The proximal and distal exposable and controllable points on the vertebrobasilar system were identified. Two imaging-based patient selection algorithms are provided using the lengths from those points to the vertebral artery dural entry point and the superoinferior distances from those points to the inferior edge of the foramen magnum. Other factors related to accessibility via the GCT were investigated.
The mean (standard deviation [SD]) area of the GCT was 45.7 (12.55) mm2. The mean (SD) depth of the abducens nerve was 14.3 (1.42) mm. The mean (SD) superoinferior distances from the foramen magnum to those points were 23.1 (7.39), 24.7 (8.25), 30.0 (9.56), and 32.6 (7.79) mm, respectively. The lower segment of the vertebrobasilar system was more superficial in the setting of a high-lying vertebrobasilar junction (VBJ) than a low-lying VBJ.
We describe the GCT in an extended retrosigmoid approach for high-riding PICA aneurysms and evaluate the spatial relationship of the neurovascular structures within it. Two potential algorithms are offered for preoperative patient selection.
扩大乙状窦后入路可为某些高位小脑后下动脉（PICA）动脉瘤的夹闭重建提供足够的空间。
定量研究舌咽神经-耳蜗神经三角（GCT）及其内部解剖结构。
对 10 侧尸头进行扩大乙状窦后入路开颅，在每个标本中识别 GCT。测量 GCT 的基底长度和面积。测量椎基底动脉系统的深度和外展神经至 GCT 的距离。确定椎基底动脉系统近端和远端可暴露和可控制的点。基于影像学提供了两种患者选择算法，使用这些点到椎动脉硬脑膜入口的距离以及这些点到枕骨大孔下缘的上下距离。还研究了通过 GCT 可到达性的其他相关因素。
GCT 的平均（标准差）面积为 45.7（12.55）mm2。外展神经的平均（SD）深度为 14.3（1.42）mm。从枕骨大孔到这些点的平均（SD）上下距离分别为 23.1（7.39）、24.7（8.25）、30.0（9.56）和 32.6（7.79）mm。高位椎基底动脉结合部（VBJ）比低位 VBJ 时，椎基底动脉系统的下段更浅。
我们描述了在高位 PICA 动脉瘤的扩大乙状窦后入路中 GCT，并评估了其内神经血管结构的空间关系。提供了两种潜在的术前患者选择算法。
