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Chapter 13 - Combined Retrosigmoid and Orbitozygomatic Approach

from Section II - Open Combined Approaches

Published online by Cambridge University Press:  05 October 2021

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Summary

Neurosurgical lesions that span the supratentorial and infratentorial compartments can pose a significant challenge. Although these lesions are traditionally addressed using transpetrosal approaches, skull base principles can be maintained and successful resection achieved with the combination of less extensive surgical approaches. Through the combination of the orbitozygomatic and retrosigmoid approaches, the vast majority of anterior, middle, and posterior fossa pathology can be successfully resected. Over the past two decades at our institution, the orbitozygomatic and retrosigmoid approaches have largely replaced the more traditional transpetrosal approaches, with the combined two-stage orbitozygomatic-plus-retrosigmoid approach being utilized when necessary.

Type
Chapter
Information
Integrated Management of Complex Intracranial Lesions
Open, Endoscopic, and Keyhole Techniques
, pp. 140 - 149
Publisher: Cambridge University Press
Print publication year: 2021

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References

Acknowledgments

The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

Bambakidis, NC, Kakarla, UK, Kim, LJ, Nakaji, P, Porter, RW, Daspit, CP, et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery. 2008;62(6 Suppl 3):1182–91.CrossRefGoogle ScholarPubMed
Bernardo, A, Evins, AI, Visca, A, Stieg, PE. The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study. Neurosurgery. 2013;72(2 Suppl Operative):ons194–207.Google Scholar
Chanda, A, Nanda, A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study. Neurosurgery. 2002;51(1):147–59; discussion 59–60.Google Scholar
Wu, CY, Lan, Q. Quantification of the presigmoid transpetrosal keyhole approach to petroclival region. Chin Med J (Engl). 2008;121(8):740–4.Google Scholar
Cho, CW, Al-Mefty, O. Combined petrosal approach to petroclival meningiomas. Neurosurgery. 2002;51(3):708–16; discussion 16–18.CrossRefGoogle ScholarPubMed
Horgan, MA, Anderson, GJ, Kellogg, JX, Schwartz, MS, Spektor, S, McMenomey, SO, et al. Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg. 2000;93(1):108–12.Google Scholar
Janjua, MB, Caruso, JP, Greenfield, JP, Souweidane, MM, Schwartz, TH. The combined transpetrosal approach: anatomic study and literature review. J Clin Neurosci. 2017;41:3640.CrossRefGoogle ScholarPubMed
Miller, CG, van Loveren, HR, Keller, JT, Pensak, M, el-Kalliny, M, Tew, JM Jr. Transpetrosal approach: surgical anatomy and technique. Neurosurgery. 1993;33(3):461–9; discussion 9.Google Scholar
Miller, ME, Mastrodimos, B, Cueva, RA. Facial nerve function after the extended translabyrinthine approach. J Neurol Surg B Skull Base. 2015;76(1):16.Google Scholar
Yang, J, Zhang, F, Xu, A, Li, H, Ding, Z. Comparison of surgical exposure and maneuverability associated with microscopy and endoscopy in the retrolabyrinthine and transcrusal approaches to the retrochiasmatic region: a cadaveric study. Acta Neurochir (Wien). 2016;158(4):703–10.Google Scholar
Chang, SW, Wu, A, Gore, P, Beres, E, Porter, RW, Preul, MC, et al. Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery. 2009;64(3 Suppl):ons44-51.Google Scholar
Mason, E, Rompaey, JV, Solares, CA, Figueroa, R, Prevedello, D. Subtemporal retrolabyrinthine (posterior petrosal) versus endoscopic endonasal approach to the petroclival region: an anatomical and computed tomography study. J Neurol Surg B Skull Base. 2016;77(3):231–7.Google Scholar
Xu, F, Karampelas, I, Megerian, CA, Selman, WR, Bambakidis, NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus. 2013;35(6):E11.Google Scholar
House, WF, Hitselberger, WE. The transcochlear approach to the skull base. Arch Otolaryngol. 1976;102(6):334–42.Google Scholar
House, WF, De la Cruz, A, Hitselberger, WE. Surgery of the skull base: transcochlear approach to the petrous apex and clivus. Otolaryngology. 1978;86(5):ORL-770–9.Google Scholar
Little, AS, Jittapiromsak, P, Crawford, NR, Deshmukh, P, Preul, MC, Spetzler, RF, et al. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension. Neurosurgery. 2008;62(5 Suppl 2):ons318–23; discussion ons23–4.Google Scholar
Siwanuwatn, R, Deshmukh, P, Figueiredo, EG, Crawford, NR, Spetzler, RF, Preul, MC. Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region. J Neurosurg. 2006;104(1):137–42.Google Scholar
Lemole, GM, Jr., Henn, JS, Zabramski, JM, Spetzler, RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg. 2003;99(5):924–30.Google Scholar
Bambakidis, NC, Kakarla, UK, Kim, LJ, Nakaji, P, Porter, RW, Daspit, CP, et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery. 2008;62(6 Suppl 3):1182–91.CrossRefGoogle ScholarPubMed
Bernardo, A, Evins, AI, Visca, A, Stieg, PE. The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study. Neurosurgery. 2013;72(2 Suppl Operative):ons194–207.Google Scholar
Chanda, A, Nanda, A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study. Neurosurgery. 2002;51(1):147–59; discussion 59–60.Google Scholar
Wu, CY, Lan, Q. Quantification of the presigmoid transpetrosal keyhole approach to petroclival region. Chin Med J (Engl). 2008;121(8):740–4.Google Scholar
Cho, CW, Al-Mefty, O. Combined petrosal approach to petroclival meningiomas. Neurosurgery. 2002;51(3):708–16; discussion 16–18.CrossRefGoogle ScholarPubMed
Horgan, MA, Anderson, GJ, Kellogg, JX, Schwartz, MS, Spektor, S, McMenomey, SO, et al. Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg. 2000;93(1):108–12.Google Scholar
Janjua, MB, Caruso, JP, Greenfield, JP, Souweidane, MM, Schwartz, TH. The combined transpetrosal approach: anatomic study and literature review. J Clin Neurosci. 2017;41:3640.CrossRefGoogle ScholarPubMed
Miller, CG, van Loveren, HR, Keller, JT, Pensak, M, el-Kalliny, M, Tew, JM Jr. Transpetrosal approach: surgical anatomy and technique. Neurosurgery. 1993;33(3):461–9; discussion 9.Google Scholar
Miller, ME, Mastrodimos, B, Cueva, RA. Facial nerve function after the extended translabyrinthine approach. J Neurol Surg B Skull Base. 2015;76(1):16.Google Scholar
Yang, J, Zhang, F, Xu, A, Li, H, Ding, Z. Comparison of surgical exposure and maneuverability associated with microscopy and endoscopy in the retrolabyrinthine and transcrusal approaches to the retrochiasmatic region: a cadaveric study. Acta Neurochir (Wien). 2016;158(4):703–10.Google Scholar
Chang, SW, Wu, A, Gore, P, Beres, E, Porter, RW, Preul, MC, et al. Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery. 2009;64(3 Suppl):ons44-51.Google Scholar
Mason, E, Rompaey, JV, Solares, CA, Figueroa, R, Prevedello, D. Subtemporal retrolabyrinthine (posterior petrosal) versus endoscopic endonasal approach to the petroclival region: an anatomical and computed tomography study. J Neurol Surg B Skull Base. 2016;77(3):231–7.Google Scholar
Xu, F, Karampelas, I, Megerian, CA, Selman, WR, Bambakidis, NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus. 2013;35(6):E11.Google Scholar
House, WF, Hitselberger, WE. The transcochlear approach to the skull base. Arch Otolaryngol. 1976;102(6):334–42.Google Scholar
House, WF, De la Cruz, A, Hitselberger, WE. Surgery of the skull base: transcochlear approach to the petrous apex and clivus. Otolaryngology. 1978;86(5):ORL-770–9.Google Scholar
Little, AS, Jittapiromsak, P, Crawford, NR, Deshmukh, P, Preul, MC, Spetzler, RF, et al. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension. Neurosurgery. 2008;62(5 Suppl 2):ons318–23; discussion ons23–4.Google Scholar
Siwanuwatn, R, Deshmukh, P, Figueiredo, EG, Crawford, NR, Spetzler, RF, Preul, MC. Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region. J Neurosurg. 2006;104(1):137–42.Google Scholar
Lemole, GM, Jr., Henn, JS, Zabramski, JM, Spetzler, RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg. 2003;99(5):924–30.Google Scholar

References

Bambakidis, NC, Kakarla, UK, Kim, LJ, Nakaji, P, Porter, RW, Daspit, CP, et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery. 2008;62(6 Suppl 3):1182–91.CrossRefGoogle ScholarPubMed
Bernardo, A, Evins, AI, Visca, A, Stieg, PE. The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study. Neurosurgery. 2013;72(2 Suppl Operative):ons194–207.Google Scholar
Chanda, A, Nanda, A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study. Neurosurgery. 2002;51(1):147–59; discussion 59–60.Google Scholar
Wu, CY, Lan, Q. Quantification of the presigmoid transpetrosal keyhole approach to petroclival region. Chin Med J (Engl). 2008;121(8):740–4.Google Scholar
Cho, CW, Al-Mefty, O. Combined petrosal approach to petroclival meningiomas. Neurosurgery. 2002;51(3):708–16; discussion 16–18.CrossRefGoogle ScholarPubMed
Horgan, MA, Anderson, GJ, Kellogg, JX, Schwartz, MS, Spektor, S, McMenomey, SO, et al. Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg. 2000;93(1):108–12.Google Scholar
Janjua, MB, Caruso, JP, Greenfield, JP, Souweidane, MM, Schwartz, TH. The combined transpetrosal approach: anatomic study and literature review. J Clin Neurosci. 2017;41:3640.CrossRefGoogle ScholarPubMed
Miller, CG, van Loveren, HR, Keller, JT, Pensak, M, el-Kalliny, M, Tew, JM Jr. Transpetrosal approach: surgical anatomy and technique. Neurosurgery. 1993;33(3):461–9; discussion 9.Google Scholar
Miller, ME, Mastrodimos, B, Cueva, RA. Facial nerve function after the extended translabyrinthine approach. J Neurol Surg B Skull Base. 2015;76(1):16.Google Scholar
Yang, J, Zhang, F, Xu, A, Li, H, Ding, Z. Comparison of surgical exposure and maneuverability associated with microscopy and endoscopy in the retrolabyrinthine and transcrusal approaches to the retrochiasmatic region: a cadaveric study. Acta Neurochir (Wien). 2016;158(4):703–10.Google Scholar
Chang, SW, Wu, A, Gore, P, Beres, E, Porter, RW, Preul, MC, et al. Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery. 2009;64(3 Suppl):ons44-51.Google Scholar
Mason, E, Rompaey, JV, Solares, CA, Figueroa, R, Prevedello, D. Subtemporal retrolabyrinthine (posterior petrosal) versus endoscopic endonasal approach to the petroclival region: an anatomical and computed tomography study. J Neurol Surg B Skull Base. 2016;77(3):231–7.Google Scholar
Xu, F, Karampelas, I, Megerian, CA, Selman, WR, Bambakidis, NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus. 2013;35(6):E11.Google Scholar
House, WF, Hitselberger, WE. The transcochlear approach to the skull base. Arch Otolaryngol. 1976;102(6):334–42.Google Scholar
House, WF, De la Cruz, A, Hitselberger, WE. Surgery of the skull base: transcochlear approach to the petrous apex and clivus. Otolaryngology. 1978;86(5):ORL-770–9.Google Scholar
Little, AS, Jittapiromsak, P, Crawford, NR, Deshmukh, P, Preul, MC, Spetzler, RF, et al. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension. Neurosurgery. 2008;62(5 Suppl 2):ons318–23; discussion ons23–4.Google Scholar
Siwanuwatn, R, Deshmukh, P, Figueiredo, EG, Crawford, NR, Spetzler, RF, Preul, MC. Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region. J Neurosurg. 2006;104(1):137–42.Google Scholar
Lemole, GM, Jr., Henn, JS, Zabramski, JM, Spetzler, RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg. 2003;99(5):924–30.Google Scholar

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