Department of Neurological Surgery, University of California, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, California, USA.
World Neurosurg. 2021 May;149:111-116. doi: 10.1016/j.wneu.2021.02.075. Epub 2021 Feb 25.
The extradural anterior petrosectomy is a widely used skull base approach to the upper petroclival region, basilar trunk, and ventral pons. However, there is significant procedure-related morbidity and a complete petrosectomy is required, as the intradural structures are not in view at the time of drilling. We describe an intradural anterior petrosectomy for aneurysms of the basilar trunk and anterior inferior cerebellar artery with intraoperative photographs and artwork to illustrate the approach.
A temporal craniotomy is made at the root of the zygoma and middle fossa floor. After opening dura, the trochlear nerve is identified at the tentorial edge. The tentorium is incised posterior to the trochlear nerve and the incision is carried forward across the cisternal segment of the trigeminal nerve toward V3 and the superior petrosal sinus. The petrous apex is identified and drilled lateral and posterior to V3 with a diamond bur. Intraoperative navigation is useful to confirm its location. Once posterior fossa dura is identified, the superior petrosal sinus may be safely cauterized and divided, connecting the tentorial incision with an incision in the posterior fossa dura, and exposing the upper basilar trunk and its branches. Additional bone is removed only as needed.
Two patients underwent successful treatment of a basilar trunk perforator and anterior inferior cerebellar artery aneurysm with a subtemporal approach and tailored intradural petrosectomy.
The intradural anterior petrosectomy allows limited drilling of the petrous apex and provides sufficient exposure of upper basilar artery aneurysms.
颅外前岩骨切除术是一种广泛应用于岩斜区上部、基底干和脑桥腹侧的颅底入路方法。然而，该手术相关的发病率较高，需要进行完整的岩骨切除术，因为在钻孔时无法看到硬膜内结构。我们描述了一种用于治疗基底干和前下小脑动脉动脉瘤的经硬脑膜前岩骨切除术，并附有术中照片和插图来阐明该方法。
在颧弓根部和中颅窝底行颞骨开颅术。打开硬脑膜后，在小脑幕缘识别滑车神经。小脑幕在滑车神经后缘切开，并向前穿过三叉神经池段，向 V3 和岩上窦延伸。识别岩锥尖端并用金刚石钻头向 V3 的外侧和后方进行钻孔。术中导航有助于确认其位置。一旦识别出后颅窝硬脑膜，可以安全地烧灼和切断岩上窦，将小脑幕切口与后颅窝硬脑膜切口连接起来，暴露上基底干及其分支。仅在需要时去除额外的骨。
2 例患者通过经颞下入路和定制的经硬脑膜岩骨切除术成功治疗了基底干穿支和前下小脑动脉动脉瘤。
经硬脑膜前岩骨切除术允许对岩锥尖端进行有限的钻孔，并提供足够的上基底动脉动脉瘤暴露。
