Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
World Neurosurg. 2021 Aug;152:e128-e137. doi: 10.1016/j.wneu.2021.05.055. Epub 2021 May 24.
The endoscope-assisted subtemporal key-hole epidural approach (ESKEA) has been recently described. The aim of this study was to measure working volumes and exposure of key areas of the middle cranial fossa provided by this approach.
Four fresh frozen cadaver heads were dissected to analyze 3 modular corridors (1A, 1B, and 2) harvested through ESKEA. A step-by-step dissection was performed, and key anatomic landmarks were recorded. A GTxEyesII-ApproachViewer was used to quantify the working volume and exposure of 4 different regions (sphenoorbital, parasellar, superior petrous apex, and squamopetrous). For each corridor, 3 incremental degrees of temporal dural retraction (5, 10, and 15 mm) were tested.
The working volume of all corridors progressively increased with degree of retraction: Corridors 1A, 1B, and 2 showed a gain in working volume of 21%, 27%, and 19% from 5 mm to 10 mm retraction, respectively, and a gain of 40%, 45%, and 44% from 5 mm to 15 mm retraction, respectively. The sphenoorbital area was exposed (27%-45%) through corridor 1A, and exposure significantly increased with the degree of retraction. Corridor 1B provided optimal exposure of parasellar areas (86%-100%) and superior petrous apex (70%-87%) regardless of the degree of retraction. The squamopetrous area was satisfactorily addressed through corridor 2 (88%) only with the highest degree of retraction.
ESKEA can be conceived as a modular approach: the 3 surgical corridors have specific working volumes, which are clearly influenced by the degree of temporal lobe retraction, and provide exposure of different middle cranial fossa areas.
最近描述了内窥镜辅助颞下锁孔硬膜外入路（ESKEA）。本研究的目的是测量该入路提供的中颅窝关键区域的工作容积和暴露情况。
对 4 个新鲜冷冻的尸头进行解剖，以分析通过 ESKEA 获得的 3 个模块通道（1A、1B 和 2）。进行逐步解剖，并记录关键解剖标志。使用 GTxEyesII-ApproachViewer 来量化 4 个不同区域（眶蝶、鞍旁、岩上尖端和鳞岩部）的工作容积和暴露情况。对于每个通道，测试了 3 个递增的颞叶硬脑膜回缩度（5、10 和 15mm）。
所有通道的工作容积均随回缩度的增加而逐渐增加：通道 1A、1B 和 2 在 5mm 至 10mm 回缩时分别增加了 21%、27%和 19%的工作容积，在 5mm 至 15mm 回缩时分别增加了 40%、45%和 44%的工作容积。眶蝶区域通过通道 1A 暴露（27%-45%），并且暴露度随着回缩度的增加而显著增加。通道 1B 无论回缩度如何，都能提供最佳的鞍旁区域（86%-100%）和岩上尖端（70%-87%）暴露。只有在最高程度的回缩时，通道 2 才能满意地处理鳞岩部区域（88%）。
ESKEA 可以被设想为一种模块化的方法：3 个手术通道具有特定的工作容积，这些容积明显受到颞叶回缩度的影响，并提供了不同的中颅窝区域的暴露。
