Tamura Ryota, Ueda Ryo, Karatsu Kosuke, Sayanagi Taichi, Takahara Kento, Hino Utaro, Iwama Takashi, Nogawa Hirotsugu, Nakaya Masato, Horiguchi Takashi, Toda Masahiro
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Front Surg. 2023 Feb 27;10:1094387. doi: 10.3389/fsurg.2023.1094387. eCollection 2023.
A combined transpetrosal approach (CTP) is often used for large lesions in the posterior cranial fossa (PCF). Although CTP provides a wide surgical corridor, it has complex and time-consuming bony work of mastoidectomy and cosmetic issues. Here, we describe a simple combined surgical technique to approach the supratentorial region, anterolateral surface of the brainstem, petroclival region, and foramen magnum by drilling only the petrous apex with a combination of retrosigmoid approach (RA).
A 27-year-old female was referred with extra-axial left cerebellopontine angle space-occupying epidermoid cyst extending to the prepontine cistern, anterior to the basilar artery, superior to the chiasma, and caudally to the foramen magnum. A one-stage surgical procedure using the anterior transpetrosal approach (ATP) and RA was performed after one-piece temporal-suboccipital craniotomy. These two approaches complemented each other well. Near-total removal was achieved.
A one-stage surgical procedure using ATP and RA provides the wider viewing and better visualization of the PCF with minimal technical difficulty.
联合经岩骨入路（CTP）常用于后颅窝（PCF）的大型病变。尽管CTP提供了宽阔的手术通道，但它具有复杂且耗时的乳突切除骨操作以及美容问题。在此，我们描述一种简单的联合手术技术，通过仅磨除岩尖并结合乙状窦后入路（RA）来进入幕上区域、脑干前外侧表面、岩斜区和枕骨大孔。
一名27岁女性因轴外左侧小脑脑桥角占位性表皮样囊肿就诊，该囊肿延伸至脑桥前池、基底动脉前方、视交叉上方及枕骨大孔尾部。在进行整块颞下枕部开颅术后，采用经岩骨前入路（ATP）和RA进行一期手术。这两种入路配合良好，实现了近全切除。
采用ATP和RA的一期手术操作能以最小的技术难度提供更宽阔的视野并更好地显露后颅窝。
